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BUYER REPRESENTATION AGREEMENT DATA FORM
FOR RESIDENTIAL PROPERTIES
2ND BUYER (for identification purposes)
FIRST NAME
1ST BUYER (for identification purposes)
FIRST NAME
LAST NAME
LAST NAME
STREET NO.
STREET NAME / ADDRESS
STREET NO.
STREET NAME / ADDRESS
APT/UNIT # MUNICIPALITY POSTAL CODE
APT/UNIT # MUNICIPALITY POSTAL CODE
RES. TEL.
BUS. TEL.
RES. TEL.
BUS. TEL.
FAX
CELLULAR
FAX
CELLULAR
E-MAIL
E-MAIL
GEOGRAPHIC AREA OF REFERENCE (CHECK APPROPRIATE BOXES)
ALL Central TREB Districts OR C01 C02 C03 C04 C06 C08 C09 C10 C11 C12 C14 C15 ALL East TREB Districts OR E01 E02 E03 E04 E05 E07 E08 E09 E10 E11 E13 E14 E15 E16 E17 E19 E20 E21 EXPIRY DATE
M M D D Y Y Y Y
C07 C13
E06 E12 E18
ALL North TREB Districts OR N01 N02 N03 N04 N06 N07 N08 N10 N12 N13 N14 N15 N17 N18 N19 N20 N22 N23 N24
N05 N11 N16 N21
ALL West TREB Districts OR W01 W02 W03 W04 W06 W07 W08 W09 W12 W13 W14 W15 W17 W18 W19 W20 W22 W23 W24 W25 W27 W28 W29 ONTARIO
W05 W10 W16 W21 W26
ALL X X01 X06 X11 X16 X21 X26 X31
Districts OR X02 X03 X07 X08 X12 X13 X17 X18 X22 X23 X27 X28 X32 X35
X04 X09 X14 X19 X24 X29 X37
X05 X10 X15 X20 X25 X30 X98
TREB METRO AREA PRICE FROM
HOLDOVER DAYS
PRICE TO
GENERAL REMARKS
BROKERAGE COMPANY NAME
OFFICE PHONE
FAX NO.
BROKER 1/SALESPERSON 1
BROKER 1/SALESPERSON 1 PHONE
BROKER 2/SALESPERSON 2
BROKER 2/SALESPERSON 2 PHONE
For the purposes of this Buyer Representation Agreement Data Form (this “Form”), the term “Buyer” has the meaning set out in the Buyer Representation Agreement between __________________________________________ and __________________________________________ dated __________________________________________ (the “Agreement”) and the term “Buyer’s Brokerage” has the same meaning as the term “Brokerage” in the Agreement. USE AND DISTRIBUTION OF INFORMATION: The Buyer consents to the collection, use, transfer and disclosure of its personally identifiable information (the “Information”) and related data (the Information and the data being collectively referred to as the “Data”) contained in this Form for use in the Buyer Registry Service (the “BRS”) as follows: (i) to enable the Buyer’s Brokerage, other brokerages, brokers, salespersons and others who assist such brokerages, including, but not limited to, brokerages, that may be in direct contact with the Buyer, to use the BRS to try to determine if the Buyer is already registered in the BRS on the basis of a current (i.e., non-expired) Buyer Representation Agreement with another brokerage including, but not limited to, brokers/salespersons in their own real estate brokerage; (ii) to enable the Buyer’s Brokerage to easily identify and manage its own client records, information and data in order to provide the Buyer with real estate-related services including, but not limited to: locating, assessing and qualifying properties for the Buyer; advertising on behalf of the Buyer by making the Buyer’s non-personally identifiable information, such as potential purchase price, desired location(s) and other preferences, available in the BRS. The Buyer’s identity will not be disclosed by, but may be confirmed as being registered in, the BRS, except to the Buyer’s Brokerage. The Buyer agrees, that in the event of the termination or expiration of the Buyer Representation Agreement with the Buyer’s Brokerage, the Buyer’s Brokerage will have two (2) business days following such termination or expiration to remove the Information from the BRS, provided that the Buyer’s Brokerage may retain the Information for its own records in accordance with its privacy policy and applicable law.
This form is to be completed when registering Buyers on the Buyer Registry System. This form is not a replacement for the Buyer Representation Agreement.
BUYER SIGNATURE BUYER SIGNATURE DATE DATE
WEBForms TM Nov/2007
REV. 2008
FORM 380