Approved Nevada Real Estate Division Page 1 of 1 524
Replaces all previous editions Revised 05/01/05
CONSENT TO ACT
This form does not constitute a contract for services nor an agreement to pay compensation.
DESCRIPTION OF TRANSACTION: The real estate transaction is the sale and purchase; or lease; of
Property Address:
.
In Nevada, a real estate licensee may act for more than one party in a real estate transaction however, before the licensee
does so, he or she must obtain the written consent of each party. This form is that consent. Before you consent to having
a licensee represent both yourself and the other party, you should read this form and understand it.
Licensee: The licensee in this real estate transaction is
(“Licensee”) whose
license number is
and who is affiliated with (“Brokerage”).
Seller/Landlord
Print Name
Buyer/Tenant
Print Name
CONFLICT OF INTEREST: A licensee in a real estate transaction may legally act for two or more parties who have
interests adverse to each other. In acting for these parties, the licensee has a conflict of interest.
DISCLOSURE OF CONFIDENTIAL INFORMATION: Licensee will not disclose any confidential information for 1
year after the revocation or termination of any brokerage agreement entered into with a party to this transaction, unless
Licensee is required to do so by a court of competent jurisdiction or is given written permission to do so by that party.
Confidential information includes, but is not limited to, the client’s motivation to purchase, trade or sell, which if
disclosed, could harm one party’s bargaining position or benefit the other.
DUTIES OF LICENSEE: Licensee shall provide you with a “Duties Owed by a Nevada Real Estate Licensee”
disclosure form which lists the duties a licensee owes to all parties of a real estate transaction, and those owed to the
licensee’s client. When representing both parties, the licensee owes the same duties to both seller and buyer. Licensee
shall disclose to both Seller and Buyer all known defects in the property, any matter that must be disclosed by law, and
any information the licensee believes may be material or might affect Seller’s/Landlord’s or Buyer’s/Tenant’s decisions
with respect to this transaction.
NO REQUIREMENT TO CONSENT: You are not required to consent to this licensee acting on your behalf. You may
− Reject this consent and obtain your own agent,
− Represent yourself,
− Request that the licensee’s broker assign you your own licensee.
CONFIRMATION OF DISCLOSURE AND INFORMATION CONSENT
BY MY SIGNATURE BELOW, I UNDERSTAND AND CONSENT: I am giving my consent to have the above
identified licensee act for both the other party and me. By signing below, I acknowledge that I understand the
ramifications of this consent, and that I acknowledge that I am giving this consent without coercion.
I/We acknowledge receipt of a copy of this list of licensee duties, and have read and understand this disclosure.
Seller/Landlord Date Time Buyer/Tenant Date Time
Seller/Landlord Date Time Buyer/Tenant Date Time
