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Name*

Email*

Organization

Country Code (United States = +1)*

Phone (Mobile Preferred)*

Are you a United States Citizen?*

Select Your Location:*

Address (United States)*

Address (International)*

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What amount of liquid funds do you have available to put towards a business acquisition?

Do you have non-borrowed liquid funds available for a business acquisition equal or greater than 10% of the total purchase price?*

Yes

Principal Buyer*

Potential Competitor*

Do you require roll-over equity, contingent payments or expect the seller to provide financing in excess of 10%.*

I am a business broker/intermediary/advisor*

Yes

Client Name*

Client Email*

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Listing Interest

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Listing URL

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Listing ID

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Listing Price

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Broker First Name

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Broker Last Name

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Broker Email

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Buyer Referred

Working With Real Estate Agents Disclosure (For Buyers)

IMPORTANT

This form is not a contract. Signing this disclosure only means you have received it.

In a real estate sales transaction, it is important that you understand whether an agent represents you.
Real estate agents are required to (1) review this form with you at first substantial contact - before asking for or receiving your confidential information and (2) give you a copy of it after you sign it. This is for your own protection.
Do not share any confidential information with a real estate agent or assume that the agent is acting on your behalf until you have entered into an agreement with the agent to represent you. Otherwise, the agent can share your confidential information with others.

Note to Agent: Check all relationship types below that may apply to this buyer.

Buyer Agency

Buyer Agency: If you agree, the agent who gave you this form (and the agent’s firm) would represent you as a buyer agent and be loyal to you. You may begin with an oral agreement, but your agent must enter into a written buyer agency agreement with you before making a written offer or oral offer for you. The seller would either be represented by an agent affiliated with a different real estate firm or be unrepresented.

Dual Agency & Designated Dual Agency

Dual Agency: Dual agency will occur if you purchase a property listed by the firm that represents you. If you agree, the real estate firm and any agent with the same firm (company), would be permitted to represent you and the seller at the same time. A dual agent’s loyalty would be divided between you and the seller, but the firm and its agents must treat you and the seller fairly and equally and cannot help you gain an advantage over the other party.*

Designated Dual Agency: If you agree, the real estate firm would represent both you and the seller, but the firm would designate one agent to represent you and a different agent to represent the seller. Each designated agent would be loyal only to their client.*

Unrepresented Buyer

Unrepresented Buyer (Seller subagent): The agent who gave you this form may assist you in your purchase, but will not be representing you and has no loyalty to you. The agent will represent the seller. Do not share any confidential information with this agent.

Initials*

*Any agreement between you and an agent that permits dual agency must be put in writing no later than the time you make an offer to purchase.

Note to Buyer: For more information on an agent’s duties and services, refer to the NC Real Estate Commission’s “Questions and Answers on: Working With Real Estate Agents” brochure at ncrec.gov (Publications, Q&A Brochures) or ask an agent for a copy of it.

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