EXCLUSIVE RIGHT TO REPRESENT BUYER AGREEMENT (the "Agreement")

1.
EXCLUSIVE RIGHT: Buyer(s)
appoints
Coldwell Banker Residential Brokerage (hereinafter "Coldwell" or "Broker")) as Buyer's exclusive agent for the purpose
of assisting Buyer to find and/or acquire an interest in suitable real property acceptable to Buyer.
2.

PROPERTY: Property means residential property.

3.
TERM OF AGREEMENT: This agreement shall begin on
and expire at
midnight on
unless the Buyer client is in a pending negotiation or has entered into a
fully signed purchase agreement, (either situation hereinafter referred to as a "Pending Transaction") then this Agreement
will extend through the closing date of that Pending Transaction.
4.

BROKER'S DUTIES: Coldwell agrees:

(a)

To attempt to locate a property acceptable to Buyer;

(b)

To negotiate on Buyer's behalf terms and conditions agreeable to Buyer; and,

(c)

To act in Buyer's interest regarding the location, purchase or exchange of a property.

(d) Coldwell has no duty to conduct an independent inspection of the Property for the benefit of Buyer and has no duty
to independently verify the accuracy or completeness of statements made by a seller or independent inspectors. Coldwell
has no duty to conduct an independent investigation of Buyer's financial condition or to verify the accuracy or
completeness of any statement made by Buyer.
5.

BUYER'S DUTIES: Buyer agrees:

(a)

To tell Coldwell about all past and current contacts with any real property or any other real estate agents;

(b) To utilize Coldwell exclusively in following up leads or information about a property no matter what the source of
such lead or information;
(c)

To cooperate with Coldwell and be reasonably available to examine real property;

(d)

Upon request, to give Coldwell financial and personal info regarding Buyer's needs and ability to purchase; and,

(e)

To schedule all appointments to see a property exclusively through Coldwell..

6.

OTHER TERMS AND CONDITIONS:

(a) Buyer understands that Coldwell may represent other buyers and show and sell other buyers the same properties.
Buyer understands and acknowledges that if any of Coldwell's clients have interest in a particular property, that
information is considered to be confidential and will not be disclosed to any other clients.
(b) Coldwell may share and disclose non-confidential information about Buyer with other agents who offer real
property for sale.
(c) Buyer understands that this Agreement is an exclusive appointment and represents and warrants that it does not
have a similar agreement with any other broker. Buyer acknowledges and understands that if the aforesaid representation
and warranty is incorrect, Buyer maybe be liable for the payment of more than one brokerage fee. Buyer agrees not to
enter into another exclusive agreement with any other real estate broker unless this Agreement has terminated.
(d)

This Agreement may be terminated if the following conditions are met;

1)

The Agreement expires; or buyer and broker mutually agree to terminate this Agreement, in writing, prior
to expiration.

2) Broker reserves the right to re-assign you to another agent within the firm or to refer you to another agency
for representation should the parties mutually decide that is best.
1
CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779
Phillip King
Phone: (631)542-5345
Fax: (631)236-1839
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www.zipLogix.com

7.

BROKERS FEE:

(a) Coldwell's commission is

% of the purchase price (hereinafter "Fee").Coldwell is authorized and
instructed by the Buyer to request payment of its Fee from the listing broker or seller. Buyer shall be obligated to pay
any portion of the commission which is less than
% of the purchase price. Coldwell shall be entitled to
receive additional compensation or bonuses and incentives paid by the listing broker or seller. Even though Coldwell's
Fee may be paid by a seller or listing broker, Coldwell will continue to represent the interests of the Buyer.
(b) If Buyer buys a property within
days after the ending date of this contract, Buyer will pay Coldwell's
Fee if Buyer learned of the property during the term of this contract.
Buyer Initials / Date
(c)

Buyer Initials / Date

Coldwell Initials / Date

Coldwell's Fee is due no later than the date on which title to the real property transfers to Buyer.

The obligation to pay Coldwell's Fee will automatically extend through the date of the actual closing and transfer of title,
even though this date occurs after the term of this Agreement or any extension expires.
9.
FAIR HOUSING: IT IS UNLAWFUL UNDER FEDERAL AND/OR STATE LAW TO DISCRIMINATE ON
THE BASIS OF RACE, CREED, COLOR, NATIONAL ORIGIN, ANCESTRY, SEX, SEXUAL ORIENTATION,
MARITAL STATUS, AGE, LEARNING DISABILITY, MENTAL DISABILITY, FAMILIAL STATUS AND/OR
PHYSICAL DISABILITY.
10.

DUAL AGENCY:

(a) Buyer understands that Broker represents sellers in addition to buyers and Buyer agrees that Broker may represent
both Buyer and Seller in the purchase and sale of a property and that Broker may be the agent of both the Buyer and a
seller. In that event, Buyer consents to and confirms this consent to a possible dual representation.
(b) In the event of a dual representation, Buyer agrees Broker shall not be required to and shall not disclose to either
party any personal, financial or other confidential information without the express written consent of the party whose
information is disclosed, other than information related to material property defects which are known to Broker and any
other information Broker is required to disclose by law.
(c)

Broker may not disclose;

(i) To the Buyer that a Seller will accept less than the asking price, or to the Seller that the Buyer can or will pay
more than what is stated in a written offer unless instructed by that client in writing;
(ii)

The motivation of either client, unless otherwise instructed to do so by the respective client;

(iii) That the Buyer or the Seller will agree to financing terms other than those offered, unless instructed in
writing by the respective client.
(d) Property information available through the Multiple Listing Service or other sources, including listed and sold
properties, which has been requested by either client, will be disclosed to both clients.
(e)

Broker shall remain impartial to each client and shall facilitate a mutually agreed upon sale.

(f)

Broker agrees to immediately inform Buyer when Broker is showing Buyer a Seller client's property.

(g)

Broker shall be able to perform in a dual capacity with the written and informed consent of both clients.

11.

DESIGNATED AGENCY:

In the event the Brokerage Firm represents the Buyer and the Seller in the same transaction and there are two different
agents involved, the Firm can designate one agent to represent the sole interests of the Buyer and designate another agent
to represent the sole interests of the Seller with the client's written authorization and informed consent. This document
shall serve as written authorization from the Buyer.
2

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12. GENERAL CONSIDERATIONS: Buyer and Broker both understand that this is a binding agreement and
either party may enforce their rights under this Agreement in a court of law. If Buyer or Broker commences litigation to
enforce their rights under this Agreement, the prevailing party shall be entitled to be paid as part of the award, its costs
and expenses, including attorney's fees. If Buyer has questions concerning this transaction and/or any documents
executed in connection with this transaction, the legal title to property, tax considerations, property inspections,
engineering, or the uses of neighboring properties, Buyer should consult with an attorney, a tax advisor, a building
inspector or appropriate governmental agencies.
Execution by Facsimile, The parties agree that this Agreement and any attached addenda may be transmitted between
them by facsimile machine and the parties intend that a faxed Agreement containing either the original and/or copies of
the signature of all parties shall constitute a binding Agreement.

Buyer

Coldwell Banker Residential Brokerage

Date

Date
Street

Authorized Agent
Zip

City/State
Date
Buyer

Authorized Agent

Date

Street
Zip
City/State

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Test Buyer

For use in NY

Issued by

REAL ESTATE EDITION

$100
Trade Service Call Fee

Pricing and Application

1

Complete your enrollment form

Select your coverage

Agreement Number (provided when AHS receives your application)

BUYER HOME PROTECTION PLAN PACKAGE

Shield
Essential

PROPERTY INFORMATION

AGE OF HOME (YRS)

<10

Single Family Home (SFH)

$490 $590 $735 $860 $815 $980

Property Address to be Covered

Year Built

City

State

ZIP

Phone Number

Email Address

Mailing Address - Only if different from covered property

BUYER INFORMATION

<10

$610

New Construction SFH (yrs. 2-5)

$1,305

$1,735

$1,855

$780

$1,170

$1,380

SFH/Condo/
Townhome/
New
Mobile Home Construction

Additional Refrigerators*

$15

$40

Well Pump and Septic System Pumping

& Septic Sewage Ejector Pump**
Swimming Pool**

$370

$985

$180

$480

Spa Equipment

$180

$480

Swimming Pool/Spa Equipment (shared equipment)** $180

$480
$720

First Name

Last Name

Saltwater Pool Equipment**

Phone Number

Email Address

*Available only with the ShieldPlus and ShieldComplete Packages

**Not available for Condo/Townhome/Mobile Home

Buyer

$270

SELLER COVERAGE OPTION

Same covered items as the ShieldEssential package

Mailing Address - Only if different from covered property

REAL ESTATE COMPANY INFORMATION

Initiating Real Estate Associate

>10

$550

BUYER OPTIONS

Last Name

>10

$390

SELLER INFORMATION
First Name

<10

Shield
Complete

Condo/Townhome/Mobile Home

New Construction Condo (yrs. 2-5)

Listing Expiration Date (if selling)

>10

Shield
Plus

Yes, add to my ShieldEssential,

ShieldPlus or ShieldComplete selection above

Seller

$75

Real Estate Company

Main Office Phone Number

Fax Phone Number

Agent Name
Agent Email

Cooperating Real Estate Associate

Main Office Phone Number

Buyer

Seller

Fax Phone Number

Agent Name
Agent Email

CLOSING COMPANY
Closing Company Name
Phone Number

Fax Address

Estimated Closing Date

Closing Number

Closing Representative Name

Email Address

SEND US YOUR ENROLLMENT APPLICATION

Mail with Payment

AHS, P.O. Box 2803
Memphis, TN 38101
Mail without Payment
AHS, P.O. Box 849
Carroll, IA 51401

Phone: 866-797-4788
Fax: 800-329-2478
Espaol: 800 250 2025
Online: www.ahswarranties.com/cb

Total & Sign

Buyer Home Protection Plan

Buyer Options Total
Seller Coverage Option
Grand Total

$
$
$
$

NOTE: Unless otherwise noted, all prices shown are for a one-year
Agreement Term for homes under 5,000 sq. feet. To obtain quotes for
Single Family Homes over 5,000 sq. feet, for multiple unit properties,
and for 2 year pricing plans, please call 866-797-4788.
American Home Shield may provide compensation to real estate brokers
and their related companies for services provided in connection with its Home
Warranty program. In connection with the program, a broker may provide
information regarding you and your home to AHS. By submitting this
application, you authorize the broker to share such information with AHS and
authorize AHS to use such information in connection with its program. You
are not required to buy a home warranty. If you would like to purchase one, it
does not require the listing or purchase of real estate through a franchised
office as a condition of purchase.
I accept the benefits of the Coldwell Banker Home Protection Plan
coverage. I received a copy of the Coldwell Banker Home Protection Plan
Agreement and understand the key terms, coverage, limitations and
exclusions, and I had the opportunity to ask questions regarding such
coverage.
I decline the opportunity to purchase the Coldwell Banker Home
Protection Plan coverage.

Signature

Date

Signature

Date

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779

Phone: (631)542-5345
Fax:(631)236-1839
Phillip King
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipLogix.com

7
Test Buyer

PLANS AT A GLANCE
Industry-Leading Coverage and Quality
ShieldEssential

ShieldPlus

ShieldComplete

Systems
Air Conditioning (Including geothermal systems)
Heating (including geothermal systems)
Ductwork
Plumbing (including stoppages; sump pumps; plumbing sewage ejector pumps)
Electrical
Water Heaters
Appliances
Washer
Dryer
Refrigerator w/Ice Maker and dispenser (Kitchen refrigerator only)
Built-in Microwave Ovens
Dishwashers
Garbage Disposals
Ranges/Ovens/Cooktops
Additional Home Items
Ceiling Fans
Telephone Wiring

Doorbells
Garage Door Openers
Instant Hot/Cold Water Dispensers
Built-In Exhaust/Attic/Whole House Fans
Same Level of Coverage Across All Packages
Lack of Maintenance
Rust & Corrosion

Sediment
Refrigerant Recapture, Reclaim & Disposal
Removal of Defective Equipment
Mismatched Systems
Undetectable Pre-existing Conditions
Improper Installations, Repairs or Modifications
Permits ($250 per Agreement Term)
Code Violations ($250 per Agreement Term)
Optional Coverage for Buyers (available for an additional cost)
Additional Refrigerators (up to 4, including wine refrigerators up to 6 cubic feet)
Well Pump and Septic System Pumping & Septic Sewage Ejector Pump

Available

Available

Available
Available

Available

Swimming Pool or Spa Equipment

Available
Available

Swimming Pool/Spa Equipment (shared equipment)

Available

Available

Available

Saltwater Pool Equipment

Available

Available

Available

Available

As always, homeowners should refer to their Coldwell Banker Home Protection Plan Agreement for specific coverage information and
limitations.
To download a Sample Agreement visit ahshome.com.

Trade Service Call Fee

There is a Trade Service Call Fee per service trade (plumber, electrician, etc.), and this is typically less than
their standard service rates.

6
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New York State

DEPARTMENT OF STATE
Division of Licensing Services
P.O. Box 22001
Albany, NY 12201-2001

Customer Service: (518) 474-4429

www.dos.state.ny.us

New York State Disclosure Form for Buyer and Seller

THIS IS NOT A CONTRACT

New York State law requires real estate licensees
who are acting as agents of buyers or sellers of
property to advise the potential buyers or sellers with
whom they work of the nature of their agency
relationship and the rights and obligations it creates.
This disclosure will help you to make informed
choices about your relationship with the real estate
broker and its sales agents.
Throughout the transaction you may receive more
than one disclosure form. The law may require each
agent assisting in the transaction to present you with
this disclosure form. A real estate agent is a person
qualified to advise about real estate.
If you need legal, tax or other advice, consult with
a professional in that field.

Disclosure Regarding Real Estate

Agency Relationships
Sellers Agent
A sellers agent is an agent who is engaged by a seller
to represent the sellers interests. The sellers agent
does this by securing a buyer for the sellers home at a
price and on terms acceptable to the seller. A sellers
agent has, without limitation, the following fiduciary
duties to the seller: reasonable care, undivided loyalty,
confidentiality, full disclosure, obedience and duty to
account. A sellers agent does not represent the
interests of the buyer. The obligations of a sellers
agent are also subject to any specific provisions set
forth in an agreement between the agent and the
seller. In dealings with the buyer, a sellers agent
should (a) exercise reasonable skill and care in
performance of the agents duties; (b) deal honestly,
fairly and in good faith; and (c) disclose all facts
known to the agent materially affecting the value or
desirability of property, except as otherwise provided
by law.

Buyer's Agent
A buyers agent is an agent who is engaged by a
buyer to represent the buyers interests. The buyers

agent does this by negotiating the purchase of a home

at a price and on terms acceptable to the buyer. A
buyers agent has, without limitation, the following
fiduciary duties to the buyer: reasonable care,
undivided loyalty, confidentiality, full disclosure,
obedience and duty to account. A buyers agent does
not represent the interest of the seller. The obligations
of a buyers agent are also subject to any specific
provisions set forth in an agreement between the
agent and the buyer. In dealings with the seller, a
buyers agent should (a) exercise reasonable skill and
care in performance of the agents duties; (b) deal
honestly, fairly and in good faith; and (c) disclose all
facts known to the agent materially affecting the
buyers ability and/or willingness to perform a
contract to acquire sellers property that are not
inconsistent with the agents fiduciary duties to the
buyer.

Broker's Agents
A brokers agent is an agent that cooperates or is
engaged by a listing agent or a buyers agent (but
does not work for the same firm as the listing agent or
buyers agent) to assist the listing agent or buyers
agent in locating a property to sell or buy,
respectively, for the listing agents seller or the buyer
agents buyer. The brokers agent does not have a
direct relationship with the buyer or seller and the
buyer or seller cannot provide instructions or direction
directly to the brokers agent. The buyer and the seller
therefore do not have vicarious liability for the acts of
the brokers agent. The listing agent or buyers agent
do provide direction and instruction to the brokers
agent and therefore the listing agent or buyers agent
will have liability for the acts of the brokers agent.

Dual Agent
A real estate broker may represent both the buyer and
seller if both the buyer and seller give their informed
consent in writing. In such a dual agency situation, the
agent will not be able to provide the full range of
fiduciary duties to the buyer and seller. The
obligations of an agent are also subject to any specific
provisions set forth in an agreement between the

DOS-1736-a (Rev. 11/10)

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779
Phone: (631)542-5345
Fax: (631)236-1839
Phillip King
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipLogix.com

Test Buyer

agent, and the buyer and seller. An agent acting as a

dual agent must explain carefully to both the buyer
and seller that the agent is acting for the other party as
well. The agent should also explain the possible
effects of dual representation, including that by
consenting to the dual agency relationship the buyer
and seller are giving up their right to undivided
loyalty. A buyer or seller should carefully consider
the possible consequences of a dual agency
relationship before agreeing to such representation. A
seller or buyer may provide advance informed consent
to dual agency by indicating the same on this form.

Dual Agent with Designated Sales

Agents
If the buyer and seller provide their informed consent
in writing, the principals and the real estate broker
who represents both parties as a dual agent may
designate a sales agent to represent the buyer and
another sales agent to represent the seller to negotiate
the purchase and sale of real estate. A sales agent

works under the supervision of the real estate broker.

With the informed consent of the buyer and the seller
in writing, the designated sales agent for the buyer
will function as the buyers agent representing the
interests of and advocating on behalf of the buyer and
the designated sales agent for the seller will function
as the sellers agent representing the interests of and
advocating on behalf of the seller in the negotiations
between the buyer and seller. A designated sales agent
cannot provide the full range of fiduciary duties to the
buyer or seller. The designated sales agent must
explain that like the dual agent under whose
supervision they function, they cannot provide
undivided loyalty. A buyer or seller should carefully
consider the possible consequences of a dual agency
relationship with designated sales agents before
agreeing to such representation. A seller or buyer may
provide advance informed consent to dual agency
with designated sales agents by indicating the same on
this form.

This form was provided to me by

(print name of licensee) of

(print name of company, firm or brokerage), a licensed real

estate broker acting in the interest of the:

(

) Seller as a (check relationship below)

) Buyer as a (check relationship below)

) Seller's agent

) Buyer's agent

) Broker's agent

) Broker's agent

) Dual agent

) Dual agent with designated sales agent

For advance informed consent to either dual agency or dual agency with designated sales agents complete section
below:
(

) Advance informed consent dual agency

) Advance informed consent to dual agency with designated sales agents

If dual agent with designated sales agents is indicated above:

is appointed to represent the buyer; and

is appointed to represent the

seller in this transaction.

(I) (We)

acknowledge

receipt of a copy of this disclosure form: signature of {

Date:

X } Buyer(s) and/or {

} Seller(s):

Date:

DOS-1736-a (Rev. 11/10)

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Test Buyer

AFFILIATED BUSINESS ARRANGEMENT DISCLOSURE STATEMENT

To: (Buyer/Tenant)

From:

Coldwell Banker Residential Brokerage

Property:

If this form is being provided to you as the seller then this form refers to the property being sold. If this form is
being provided to you as a buyer or prospective buyer then this form refers to any property that you may
consider purchasing with the assistance of Coldwell Banker Residential Brokerage.

Date:
This is to give you notice that Coldwell Banker Residential Brokerage ("Broker") has a business relationship with the companies
listed below in this Statement. Realogy Group LLC owns 100% of Realogy Services Group LLC, which owns 100% of NRT LLC, which
owns 100% of Broker. Realogy Group LLC also owns 100% of each company listed below, except for the mortgage lender, in which
Realogy Services Venture Partner LLC, a subsidiary of Realogy Services Group LLC, has a 49.9% ownership interest. Realogy Group
LLC also indirectly owns the franchisors of the BETTER HOMES & GARDENS REAL ESTATE, COLDWELL BANKER,
COLDWELL BANKER COMMERCIAL, CENTURY 21, ERA, AND SOTHEBY'S INTERNATIONAL REALTY franchise systems.
Because of these relationships, Broker's referral of business to any of the companies listed below may provide Broker, Realogy Group
LLC, NRT LLC, the franchisors owned indirectly by Realogy Group LLC, and/or their employees, affiliates, or any other related parties
noted herein a financial or other benefit.
Set forth below is the estimated charge or range of charges for the settlement services listed. You are NOT required to use the listed
providers as a condition of the purchase or sale of your property. THERE ARE FREQUENTLY OTHER SETTLEMENT SERVICE
PROVIDERS AVAILABLE WITH SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU ARE
RECEIVING THE BEST SERVICES AND THE BEST RATE FOR THESE SERVICES.
COMPANIES

SETTLEMENT SERVICES

ESTIMATE OF CHARGES OR RANGE OF CHARGES

Loan origination fee

$0

Loan discount fee/points

$450

Application fee

-2% to 5% of loan amount

Castle Edge Insurance Agency, Inc.

Provides insurance agency services for
homeowner's insurance.

Homeowner's insurance premium

Rates range from $1.00 to $5.00 per $1,000 of coverage

depending on type of construction and location of property

Skyline TRG Title Agency

Provides searches of public records that
bring to your attention any known
problems with the property's title before
closing, and insures against loss due to
certain title defects.

Purchase of title policies (1108 - 1110):

Coldwell Banker Home Loans

Provides a full range of residential first
mortgage loan products and services.

$100,000 home
$250,000 home
$500,000 home

$650-$775
$1,200-$1,430
$2,100-$2,550

Search and examination

$250

Standard endorsements

$25 each or 10% of straight mortgage premium

In addition to the affiliated business relationships described above, Broker has a business arrangement with American Home Shield
Corporation ("AHS"). While Broker, Realogy Group LLC, and NRT LLC, including their subsidiaries and affiliates, do not have any
ownership interests in AHS, they may receive fees from AHS in return for their performance of services.
ACKNOWLEDGMENT
I/we have read this disclosure form, and understand that Broker is referring me/us to purchase the above-described settlement
service(s) and that Broker, Realogy Group LLC, NRT LLC, their employees and/or subsidiaries and affiliates may receive a financial or
other benefit as the result of this referral.

Buyer/Tenant Signature

Date

Buyer/Tenant Signature

Date

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779

Phone: (631)542-5345
Fax: (631)236-1839
Phillip King
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Test Buyer

ADDITIONAL NEW YORK DISCLOSURE STATEMENT FOR AFFILIATED RELATIONSHIP

WITH TITLE INSURANCE COMPANY
To: (Buyer)
From:
Coldwell Banker Residential Brokerage
Property:
If this form is being provided to you as the seller then this form refers to the property being sold.
If this form is being provided to you as a buyer or prospective buyer then this form refers to any
property that you may consider purchasing with the assistance of Coldwell Banker Residential
Brokerage.
Date:
This is to give you notice that Coldwell Banker Residential Brokerage. (Broker) has a business relationship with Title
Resource Group Settlement Services, LLC d/b/a Skyline TRG Title Agency (Skyline). Realogy Group LLC
(Realogy) indirectly owns both Broker and Skyline. Specifically, Realogy owns 100% of Realogy Services Group
LLC, which owns 100% of NRT LLC, which owns 100% of Coldwell Banker Residential Brokerage. Realogy Services
Group LLC also owns 100% of Title Resource Group LLC (TRG). Skyline is owned 100% by TRG Settlement
Services, LLP which is owned 99% by Title Resource Group Services LLC and 1% by Title Resource Group LLC.
Because of these relationships, Broker, Skyline, Realogy, Realogy Services Group, LLC, NRT LLC and TRG and/or their
employees or affiliates are likely to receive a financial or other benefit as a result of this referral to Skyline. Any money
or other thing of value received will be based on the recipients financial or other beneficial interest in Skyline, will not
be related to the amount of title insurance business the recipient refers to Skyline, and will not violate New York
Insurance Law sections 2324 or 6409 or the Federal Real Estate Settlement Procedures Act (RESPA). Broker is not
required to refer any specific amount of title insurance business to Skyline, Broker is not the sole source of business for
Skyline, and Skyline has significant and multiple sources of business. TRG will receive 100% of Skylines profit
distributions, Realogy Services Group LLC will receive 100% of TRGs profit distributions, and Realogy will receive
100% of Realogy Services Group LLCs profit distributions. Broker, however, will not receive any compensation or
other thing of value from Skyline.
YOU ARE NOT REQUIRED TO USE THE SERVICES OF SKYLINE AS A CONDITION OF THE PURCHASE OR
SALE OF YOUR PROPERTY. THERE ARE FREQUENTLY OTHER SETTLEMENT SERVICE PROVIDERS
AVAILABLE WITH SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU
ARE RECEIVING THE BEST TITLE SERVICES AND THE BEST RATE FOR THE TITLE SERVICES.
Set forth below is the estimated charge or range of charges for the settlement services listed:
COMPANY
Title Resource Group
Settlement Services, LLC
d/b/a Skyline TRG Title
Agency

SETTLEMENT SERVICES

ESTIMATE OR RANGE OF CHARGES

Title insurance premium

$7.29 to $3.21 per

thousand dollars of policy coverage.*
*This range of charges covers, as an example, policies from
$100,000.00 to $5,000,000.00, however the cost to you will differ
depending on the policy amount

Acknowledgment of Receipt of Disclosure

I/we have read this disclosure form, and understand that Broker is referring me/us to use the above-described settlement
service provider and that Broker, Skyline, Realogy, Realogy Services Group, LLC, NRT LLC, TRG, and/or their
employees or affiliates are likely to receive a financial or other benefit as a result of this referral.
Buyers Signature

Date

Buyers Signature

Date

L:\A-f\Affiliated Business Disclosure\ADDITIONAL NEW YORK DISCLOSURE 112014.docx

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779

Phone: (631)542-5345
Fax: (631)236-1839
Phillip King
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Test Buyer

DISCLOSURE TO SELLER REGARDING PROPERTY CONDITION DISCLOSURE

STATEMENT
As the seller of residential real property, you are required by law to complete and sign a Property Condition
Disclosure Statement as prescribed by Real Property Law 462(2) and cause it, or a copy thereof, to be delivered
to a buyer or buyer's agent prior to the signing by the buyer of a binding contract of sale. A copy of the
Property Condition Disclosure Statement containing the signature of both the buyer and the seller must be
attached to the real estate purchase contract. If you acquire knowledge which renders materially inaccurate a
Property Condition Disclosure Statement previously provided, you must deliver a revised Property Condition
Disclosure Statement to the buyer as soon as practicable. In no event, however, will you be required to provide
a revised Property Condition Disclosure Statement after the transfer of title from you to the buyer or after the
buyer has commenced occupancy of the property. If you fail to deliver a Property Condition Disclosure
Statement to the buyer prior to the buyer signing a binding contract of sale, the buyer will be entitled to a credit
in the amount of $500.00 against the purchase price of the property upon the transfer of title.
I have received and read this disclosure notice.
Dated:
Seller

Seller
DISCLOSURE TO BUYER REGARDING PROPERTY CONDITION DISCLOSURE
STATEMENT
As the buyer of residential real property, you are entitled by law to receive from the seller a signed Property
Condition Disclosure Statement as prescribed by Real Property Law 462(2) prior to your signing of a binding
contract of sale. A copy of the Property Condition Disclosure Statement containing the signatures of both the
buyer and the seller must be attached to the real estate purchase contract. You are also entitled to receive a
revised Property Condition Disclosure Statement as soon as practicable in the event that the seller acquires
knowledge, which renders materially inaccurate a Property Condition Disclosure Statement previously
provided to you. You will not be entitled to receive a revised Property Condition Disclosure Statement after
the transfer of title from the seller to you or after you have commenced occupancy of the property. In the event
the seller fails to deliver a Property Condition Disclosure Statement to you prior to your signing a binding
contract of sale, you are entitled to receive a credit in the amount of $500.00 against the purchase price of the
property upon the transfer of title.
I have received and read this disclosure notice.
Dated:
Buyer

Buyer
CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779
Phillip King
Phone: (631)542-5345
Fax: (631)236-1839
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026

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"THE RATE OR AMOUNT OF COMMISSION CHARGED FOR

THE SALE, LEASE, APPRAISAL OR MANAGEMENT OF
REAL ESTATE SHALL BE NEGOTIATED BETWEEN EACH
MEMBER OF LIBOR AND HIS CLIENT"

THIS IS A LEGALLY ENFORCEABLE CONTRACT. YOU

SHOULD CONSIDER WHETHER YOU WISH TO CONSULT
YOUR ATTORNEY PRIOR TO SIGNING THE SAME.

Date

SALES AGREEMENT
PURCHASER:

SELLER:

Name:

Name:

Name:

Name:

Address:

Address:

The undersigned buyer hereby offers to purchase the real property owned by the seller and located at
on the following terms and conditions:
TERMS AND CONDITIONS
1. Purchase Price
2. Good faith deposit
3. Down payment payable on Formal Contract (including above deposit)
4. Subject to a mortgage of
5. Cash on closing
6. Seller's Concession
*NET TOTAL TO SELLER (minus seller's concession)

$
$
$
$
$
$(
$

*The actual Seller's Net at closing could be less after payoffs of existing mortgages, transfer fees, brokerage fees, etc. from Seller's proceeds
at closing
It is further understood and agreed that if this offer is not accepted by the seller in writing, the above good faith deposit will be totally refunded to the
buyer. IN THE EVENT, HOWEVER, THE SELLER DOES ACCEPT THIS OFFER IN WRITING, THEN SAID GOOD FAITH DEPOSIT WILL
BE DELIVERED TO THE SELLER AND THE BUYER WILL PROCEED TO COMPLETE THE TRANSACTION IN ACCORDANCE WITH
THIS PURCHASE AGREEMENT.
FINANCING
This sale is subject to and conditioned upon the buyer obtaining a (variable) (fixed rate) mortgage in the amount of $
with
interest at prevailing rate amortized over a period of not less than
years. Buyer understands that he/she/they are obligated to
make a good faith effort to obtain such financing.
The mortgage commitment to be obtained within
contract is to be signed by the parties on or about

days from the date hereof, or the date of a formal contract, whichever is later. A formal
.

PERSONAL PROPERTY
The following personal property is included in the sale and is represented by seller to be in working order. Exclusions are:
.
CLOSING
Location and address:
purchase price will be delivered by the buyer to the seller at the date of the closing which will take place on or about

. The balance of the

.

LEAD HAZARD CONTINGENCY

This agreement is contingent upon a risk assessment or inspection of the property for the presence of lead-based paint and /or lead-based paint hazards at the
Purchaser's expense until 9:00pm on the tenth calendar day after the ratification or a date mutually agreed upon. This contingency will terminate at the above
predetermined deadline unless the Purchaser (or Purchaser's agent) delivers to the Seller (or Seller's agent) a written contract addendum listing the specific existing
deficiencies and corrections needed, together with a copy of the inspection and or risk assessment report. The Seller may, at the Seller's option, within 3 days after
delivery of the addendum, elect in writing whether to correct the condition(s) prior to settlement. If the Seller will correct the condition, the Seller shall furnish the
Purchaser with certification from a risk assessor or inspector demonstrating that the condition has been remedied before the date of settlement. If the Seller does not
elect to make the repairs, or if the Seller makes a counter-offer, the Purchaser shall have 2 days to respond to the counter offer, or remove this contingency and take the
property in "as-is" condition or this contract shall become void. The Purchaser may remove this contingency at any time without cause.
*Intact lead-based paint that is in good condition is not necessarily a hazard. See EPA pamphlet: Protect Your Family from Lead in Your Home for more information

ARBITRATION
Any dispute in which a real estate broker is claiming a commission from a party hereto as a result of the transaction set forth in this agreement, and where the dispute
involves a sum of money more than $6,000, shall be resolved by arbitration before one single arbitrator. The arbitration shall be held in the county in which the real
estate, which is the subject matter of this agreement, is located. The arbitration shall be governed by the commercial rules of the National Arbitration Association. The
prevailing party in the arbitration shall be entitled to recoup all of its costs, including, but not limited to, all fees paid to the National Arbitration Association, the
arbitrator, any other administrative fees and reasonable attorney fees. Any Award of the Arbitrator shall be final and conclusive upon the parties hereto and a Judgment
thereon may be entered in the highest court of the State of New York having jurisdiction. Nothing herein contained shall prevent a broker from commencing an action,
as law or equity where such action is necessary, for the broker to obtain injunctive or other temporary relief such as the relief provided in CPLR 2701.

COMPLETE AGREEMENT
Buyer and Seller acknowledge and agree that no representations, warranties or agreements have been made with respect to the premises or the purchase price hereof
other than those set forth in the agreement. Buyer and Seller further agree that this agreement cannot be changed or modified in any way except by writing signed by
both buyer and seller.

ATTORNEY'S APPROVAL CLAUSE

This agreement is contingent upon purchaser and seller obtaining approval of this agreement by their attorney as to all matters contained therein. This contingency shall
be deemed waived, unless purchaser's or seller's attorney on behalf of their client, notifies the broker in writing of their disapproval of the agreement no later than 3
business days after full execution hereof. If purchaser's or seller's attorney notifies, then this agreement shall be deemed cancelled, null and void, and all deposits shall
be returned in full to the purchaser.

BUYER'S BROKER CLAUSE (if applicable)

Seller & Purchaser recognize Coldwell Banker Residential Brokerage as the sole broker who procured the purchaser in connection with this sale. The above amount
deposits and terms have been accepted by the seller and buyer. Included in the above selling price is a (Buyer's Broker) Commission in the amount of
$
payable to Coldwell Banker Residential Brokerage. The Buyer's Broker Commission shall be deducted from the amount of proceeds due
seller at closing.

Purchaser(s)
Broker
Attorney for Purchaser:

Tel #:

Owner/Seller(s)
by
Attorney for Seller:

Tel #:
3/2015

2015 Coldwell Banker Residential Brokerage. All Rights Reserved. Coldwell Banker Residential Brokerage fully supports the principles of the Fair Housing Act and the Equal Opportunity Act. Operated by a subsidiary of
NRT LLC. Coldwell Banker and the Coldwell Banker logo are registered service marks owned by Coldwell Banker Real Estate LLC.

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779

Phone: (631)542-5345
Fax:(631)236-1839
Phillip King
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipLogix.com

Test Buyer

WIRE FRAUD DISCLOSURE

COLDWELL BANKER RESIDENTIAL BROKERAGE IS PROVIDING WIRE FRAUD

NOTIFICATION TO ALERT BUYERS AND/OR SELLERS, AS THE CASE MAY BE, ABOUT
POTENTIAL RISKS RELATING TO THE FUNDING OF TRANSACTIONS
Disclosure to Buyer Clients Regarding Risks of Receiving Fraudulent Wiring Instructions
Criminals/hackers are targeting email accounts of various parties involved in a real estate transaction (e.g.,
lawyers, title agents, mortgage brokers, real estate agents). Among other concerns, this has led to fraudulent
wiring instructions being used to divert funds to the criminal's bank account. These emails may look like
legitimate emails from the proper party. Coldwell Banker Residential Brokerage strongly recommends that
you, your lawyers and others working on a transaction, should refrain from placing any sensitive
personal and financial information in an email, directly or through an email attachment. When you need
to share Social Security numbers, bank accounts, credit card numbers, wiring instructions or similar
sensitive information, we strongly recommend using more secure means, such as providing the
information in person, over the phone, or through secure mail or package services, whenever possible. In
addition, before you wire any funds to any party (including your lawyer, title agent, mortgage broker, or
real estate agent) personally call them to confirm it is legitimate (i.e., confirm the ABA routing number
or SWIFT code and credit account number). You should call them at a number that you obtain on your own
(e.g., the sales contract, their website, etc.) and not use the phone number in the email in order to be sure that
you are contacting a legitimate party.

Acknowledgement of Receipt:
Name:

Date

Name:

Date

2015 Coldwell Banker Residential Brokerage. All Rights Reserved. Coldwell Banker Residential Brokerage fully supports the principles of the Fair Housing Act and the Equal Opportunity Act. Operated by a subsidiary of
NRT LLC. Coldwell Banker and the Coldwell Banker logo are registered service marks owned by Coldwell Banker Real Estate LLC.

CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779

Phillip King
Phone: (631)542-5345
Fax: (631)236-1839
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026

Test Buyer
www.zipLogix.com

Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is
notified that such property may present exposure to lead from lead-based paint that may place young children at risk of
developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including
learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also
poses a particular risk to pregnant women. The seller of any interest in residential real property is required to provide the
buyer with any information on lead-based paint hazards from risk assessments or inspections in the seller's possession
and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based
paint hazards is recommended prior to purchase.
Seller's Disclosure
(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):
(i)

Known lead-based paint and/or lead-based paint hazards are present in the housing (explain).

(ii)

Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.

(b) Records and reports available to the seller (check (i) or (ii) below):
(i)

Seller has provided the purchaser with all available records and reports pertaining to lead-based paint
and/or lead-based paint hazards in the housing (list documents below).

(ii)

Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the
housing.

Purchaser's Acknowledgment (initial)

(c)

Purchaser has received copies of all information listed above.

(d)

Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.

(e) Purchaser has (check (i) or (ii) below):

(i)

received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessment or
inspection for the presence of lead-based paint and/or lead-based paint hazards; or

(ii)

waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint
and/or lead-based paint hazards.

Agent's Acknowledgment (initial)

(f)

Agent has informed the seller of the seller's obligations under 42 U.S.C. 4852d and is aware of his/her
responsibility to ensure compliance.

Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the
information they have provided is true and accurate.

Seller

Date

Seller

Date

Purchaser

Date

Purchaser

Date

Agent

Date

Agent

Date

Property Address:
CBRB - Ronkonkoma, 2395 Ocean Ave. Suite 1 Ronkonkoma, NY 11779
Phillip King
Phone: (631)542-5345
Fax: (631)236-1839
Produced with zipForm by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026

Test Buyer
www.zipLogix.com