Page 1 of 2 Effective 02/10/19 AGENCY DISCLOSURE STATEMENT The real estate agent who is providing you with this form is required to do so by Ohio law. You will not be bound to pay the Instead, the purpose of this form is to confirm that you have been s a landlord Property Address: Buyer(s): Seller(s): I. TRANSACTION INVOLVING TWO AGENTS IN TWO DIFFERENT BROKERAGES The buyer will be represented by , and . The seller will be represented by , and . II. TRANSACTION INVOLVING TWO AGENTS IN THE SAME BROKERAGE If two agents in the real estate brokerage represent both the buyer and the seller, check the following relationship that will apply: Agent(s) work(s) for the buyer and Agent(s) work(s) for the seller. Unless personally involved in the transaction, the principal ,form. As dual agents they will maintain a neutral position in the transacinformation. and will be working for both the bu.on the back of this form. As dual agents they will maintain a neutral position in the transaction and they will protect all confidential information. Unless indicated below, neither the agent(s) nor the brokerage acting as a dual agent in this transaction has a personal, family or business relationship with either the buyer or seller. If such a relationship does exist, explain: . III. TRANSACTION INVOLVING ONLY ONE REAL ESTATE AGENT Agent(s) and real estate brokerage will parties in this transaction in a neutral capacity. Dual agency is further explained on the back of ential information. Unless indicated below, neither the agent(s) nor the brokerage acting as a dual agent in this transaction has a personal, family or business relationship with either the buyer or seller. If such a relationship does exist, explain: . represent only the (check one) seller or buyer in this transaction as a client. The other party is not represented and agrees to represent his/her own best interest. CONSENT I (we) consent to the above relationships as we enter into this real estate transaction. If there is a dual agency in this transaction, I (we) acknowledge reading the information regarding dual agency explained on the back of this form. AGENT(S) BROKERAGE AGENT(S) BROKERAGE BUYER/TENANT DATE BUYER/TENANT DATE SELLER/LANDLORD DATE SELLER/LANDLORD DATE American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Effective 02/10/19 DUAL AGENCY Ohio law permits a real estate agent and brokerage to represent both the seller and buyer in a real estate transaction as long as this is disclosed to both parties and they both agree. This is known as dual agency. As a dual agent, a real estate agent and brokerage represent two clients whose interests are, or at times could be, different or adverse. For this reason, the dual agent(s) may not be able to advocate on behalf of the client to the same extent the agent may have if the agent represented only one client. As a dual agent, the agent(s) and brokerage shall: Treat both clients honestly; Disclose latent (not readily observable) material defects to the purchaser, if known by the agent(s) or brokerage; Provide information regarding lenders, inspectors and other professionals, if requested; Provide market information available from a property listing service or public records, if requested; Prepare and present all offers and counteroffers at the direction of the parties; Assist both parties in completing the steps necessary to fulfill the terms of any contract, if requested. As a dual agent, the agent(s) and brokerage shall not: n the transaction, unless such disclosure is authorized by the client or required by law; Advocate or negotiate on behalf of either the buyer or seller; Suggest or recommend specific terms, including price, or disclose the terms or price a buyer is willing to offer or that a seller is willing to accept; Engage in conduct that is contrary to the instructions of either party and may not act in a biased manner on behalf of one party. Compensation: Unless agreed otherwise, the brokerage will be compensated per the agency agreement. Management Level Licensees: Generally, the principal broker and managers in a brokerage also represent the interests of any buyer or seller represented by an agent affiliated with that brokerage. Therefore, if both buyer and seller are represented by agents in the same brokerage, the principal broker and manager are dual agents. There are two exceptions to this. The first is where the principal broker or manager is personally representing one of the parties. The second is where the principal broker or manager is selling or buying his own real estate. These exceptions only apply if there is another principal broker or manager to supervise the other agent involved in the transaction. Responsibilities of the Parties: The duties of the agent and brokerage in a real estate transaction do not relieve the buyer and seller from the responsibility to protect their own interests. The buyer and seller are advised to carefully read all agreements to assure that they adequately express their understanding of the transaction. The agent and brokerage are qualified to advise on real estate matters. IF LEGAL OR TAX ADVICE IS DESIRED, YOU SHOULD CONSULT THE APPROPRIATE PROFESSIONAL. Consent: By signing on the reverse side, you acknowledge that you have read and understand this form and are giving your voluntary, informed consent to the agency relationship disclosed. If you do not agree to the agent(s) and/or brokerage acting as a dual agent, you are not required to consent to this agreement and you may either request a separate agent in the brokerage to be appointed to represent your interests or you may terminate your agency relationship and obtain representation from another brokerage. Any questions regarding the role or responsibilities of the brokerage or its agents should be directed to: attorney or to: Ohio Department of Commerce Division of Real Estate & Professional Licensing 77 S. High Street, 20th Floor Columbus, OH 43215-6133 (614) 466-4100 American LegalNet, Inc. www.FormsWorkFlow.com