Agency Disclosure Acknowledgement
The Illinois Real Estate Licensing Act of 2010 requires by law that you be given a written Agency Disclosure. It also requires that RE/MAX Action maintain documentation that written Agency Disclosure has been given to you. These requirements apply to sellers, buyers and tenants/lessees even in cases where there is no written brokerage agreement being used.

We appreciate you taking the time to review and confirm receipt of written Agency Disclosure.
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RE/MAX Action Broker/Associate's Name *
Customer/Client Name(s) *
Customer/Client Email
Customer/Client Phone
I would like the following representation *
Choose one of the following
Consent to Dual Agency
Optional - The Act requires that written disclosure be made and informed consent given by the clients before a licensee may act as a disclosed dual agent.
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Written Agency Confirmation *
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