Buyer’s relatiOnshiP With Pa licensed BrOKer
no Business relationship (Buyer is not represented by a broker)
Transaction Licensee (Broker and Licensee(s) provide real estate services but do not represent Buyer)
seller’s relatiOnshiP With Pa licensed BrOKer
no Business relationship (seller is not represented by a broker)
Transaction Licensee (Broker and Licensee(s) provide real estate services but do not represent Seller)
Licensee(s) (Name) ________________________________________
________________________________________
State License # __________________________________________
Direct Phone(s) ___________________________________________
Cell Phone(s) ___________________________________________
Email ___________________________________________________
Licensee(s) is (check only one):
Buyer Agent (all company licensees represent Buyer)
Buyer Agent with Designated Agency (only Licensee(s) named
above represent Buyer)
Dual Agent (See Dual and/or Designated Agent box below)
Licensee(s) (Name) ________________________________________
________________________________________
State License # __________________________________________
Direct Phone(s) ___________________________________________
Cell Phone(s) ___________________________________________
Email ___________________________________________________
Licensee(s) is (check only one):
Seller Agent (all company licensees represent Seller)
Seller Agent with Designated Agency (only Licensee(s) named
above represent Seller)
Dual Agent (See Dual and/or Designated Agent box below)
Broker (Company) _______________________________________
_______________________________________
Company License # __________________________