This form recommended and approved for, but not restricted ...



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|PROPERTY

DATE OF AGREEMENT

Listing Broker (Company Name):

CONTROLLED BUSINESS DISCLOSURE

By law Keller Williams Realty Group is required to inform our Customers of any business relationships we may have with other companies. Because of these relationships, a referral to any of these companies may provide Keller Williams Realty Group a financial or other benefit. You are not required to use any of these companies as a condition for settlement of your loan on, or the purchase of the subject property. You are free to shop around to determine that you are receiving the best services and the best rates for these services.

The name of the providers is as follows: Mortgage Network Solutions, Eyewitness Settlement Services- DBA Edge Abstract, AHS, First American Home Insurance, The Warranty Group, and Allied Van Lines.

COMPANY TRANSACTION FEE DISCLOSURE

For each transaction there is a Mandatory Fee charged by Keller Williams Realty Group of $295.00. This fee may only be reduced in the instance of FHA and VA approved mortgages, bank owned properties or short sales where required by the lender.

This fee is charged to all Buyers and Sellers represented by an agent of Keller Williams Realty Group. This fee is not included in the transaction commission and covers the specific costs involved in:

• Review of all paperwork by Staff and Broker to insure entire file meets the Pennsylvania Real Estate Commission guidelines

• Coordination of settlement preparation activities by Keller Williams Realty Group office personell

• Electronic storage of entire file of documents in the Keller Williams Realty Group office for a 7 year minimum

• Electronic storage of the entire file of documents at an off site location for a 7 year minimum

• Physical storage of the entire file at an off site location for the term of 7 years

• Electronic and physical storage of entire duplicate file of documents by the Agent for the term of 7 years

DOMESTIC RELATIONS DISCLOSURE

In December of 1997, Governor Ridge signed into law legislation that allows overdue child support obligations to be placed as liens on property. All title companies now require a certification from the Domestic Relations Office of the County affected verifying that no unpaid child support has been lien against the property.

Customer Social Security Number and Date of Birth are required by the Domestic Relations Office in order to issue certification. There may be a nominal fee charged by the Domestic Relations Office that will appear on your settlement statement.

SOCIAL SECURITY DISCLOSURE AND AUTHORIZATION

In order to expedite the transfer of property Keller William Realty Group Brokers are requested to collect Social Security Numbers and Dates of Birth for all parties involved in the transaction.

Customer agrees that Broker(s), his/her agerst(s) and/or employee(s) may provide consumer’s social security number to Lenders, title agencies, credit reporting companies, or others as necessary for obtaining reports or information from a credit reporting agency, determining the existence of domestic liens, obtaining criminal background report (for prospective tenant only), ordering a mortgage payoff or for the purposes of satisfying requirements of the Patriot Act.

CONSUMER UNDERSTANDS THAT BROKER HAS NO CONTROL OVER THE USE OF ANY INFORMATION AFTER IT IS DISCLOSED TO A THIRD PARTY. CONSUMER AGREES TO RE-LEASE AND HOLD HARMLESS FROM ANY AND ALL LIABILITY FOR ANY MISUSE OR SUBSEQUENT DISCLOSURE BY ANY THIRD PARTY OF THE INFORMATION OR REPORTS DISCLOSED BY BROKER PURSUANT TO THE TERMS OF THIS AUTHORIZATION.

Presentation of Social Security and Date of Birth to Broker

[ ] Customer is providing this information to Agent at the signing of the above dated Agreement

Social Security Number Date of Birth

[ ] Customer will provide this information to Agent at such time that an acceptable Agreement of Sale is executed.

[ ] Customer will provide the information directly to the requesting party when such request is received by consumer.

COMMUNICATION DISCLOSURE AND AUTHORIZATION

Keller Williams Realty Group and real estate associates want to make sure that our Customers continue to receive excellent service in all future real estate transactions. Our office and associates conduct extensive marketing in an effort to remain in contact with our Customers. In light of the recent do not call legislation, Keller Williams Associates understand and agree that the information you have provided us will not be distributed or disclosed to any person(s) outside of the Keller Williams organization unless agreed upon and authorized by you.

I have read and expressly understand and agree by signing this disclaimer that I am allowing Keller Williams real estate associate(s) to contact me by mailing(s), telephone, facsmile(s) and/or by email(s) at my discretion by information given below. My preferred method of contact is indicated.

[ ] Phone [ ] FAX

[ ] Address

[ ] Email [ ] Other

AGREEMENT TO COOPERATE:

You agree to coopertate fully with service providers involved in this real estate transaction, including, but not limited to the title company, property inspectors, and appraisers. Please note that the law requires the title company to perform a domestic relations search and a Patriot Act serarch on all parties to a real estate transaction.

REGULATORY DISCLOSURE:

Buyer acknowledges that the property may be subject to regulations regarding zoning, housing, building, safety, fire prevention or other matters. This may include, but not be limited to , regulation of the property’s use as rental housing, acceptable commercial uses, or the ability to erect, modigy or remove impovements upon the property. Buyer agrees to contact the applicable municipalities or governing bodies to determine the regulations applicable to the inteded uses of the property. Buyer hereby represents and warrants that Buyer has not relied on any represenatation from Keller Williams Realty Group and its agents regarding regulatiion of the Property.

Circle

Initials

Keller Williams Agent has explained the Controlled Business Relationships

YES / NO

______ / ______

Keller Williams Agent has explained the Company Transaction Fee

YES / NO

______ / ______

Keller Williams Agent has explained the Domestic Relations requirements

YES / NO

______ / ______

Keller Williams Agent has explained the use of Social Security numbers

YES / NO

______ / ______

Keller Williams Agent has explained the future Communications with Customer

YES / NO

______ / ______

Keller Williams Agent has provided a Home Warranty Brochure to Customer

YES / NO

______/ ______

Customer would like to be contacted by Allied Van Lines for a Free Moving Quote

YES / NO

______ / ______

WITNESS CUSTOMER DATE

WITNESS CUSTOMER DATE | |

| | |

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