Also Referred to As Exclusive Seller Brokerage Agreement

Agent Exclusive Seller Listing Agreement FMLS# (ALSO REFERRED TO AS EXCLUSIVE SELLER BROKERAGE AGREEMENT) CBRB# State Law prohibits Broker from representing Seller as a client without first entering into a written agreement with Seller under O.C.G.A. § 10-6A-1 et. seq. For and in consideration of the mutual promises contained herein and other good and valuable consideration, , as seller (hereinafter referred to as “Seller”, and COLDWELL BANKER RESIDENTIAL , as broker and its affiliated licensees (hereinafter collectively referred to as “Broker”) do hereby enter into this Agreement, Day of , 20 11. this 1. Exclusive Listing Agreement. Seller hereby grants to Broker the exclusive right and privilege as the agent of the Seller to show and offer for sale the following described property as the real estate broker for Seller: All that tract of land lying and being in Land Lot of the District, 1ST Section of FORSYTH County, Georgia and being known as Address City, Georgia, Zip Code , according to the present system of numbering in and around this area, being more particularly described as Lot , Block - Unit - Phase/Section - of Subdivision as recorded in Plat Book , Page , FORSYTH County, Georgia records together with all fixtures, landscaping, improvements, and appurtenances, all being hereinafter collectively referred to as the "Property." The full legal description of the Property is the same as is recorded with the Clerk of the Superior Court of the county in which the Property is located and is made a part of this Agreement by reference. The term of this Agreement shall begin on the day of , 20 and shall continue through midnight on the

day of ,20 (hereinafter referred to as “Listing Period”). This Agreement may be renewed or extended by Broker and Seller. 2. Independent Contractor Relationship. This Agreement shall create an independent contractor relationship between Broker and Seller. Broker shall at no time be considered an employee of Seller. Seller acknowledges that the real estate licensees affiliated with Broker are independent contractors of Broker, and are not Broker’s employees. 3. Broker’s Duties to Seller. Broker’s sole duties to Seller shall be to: A. Use Broker’s best efforts to procure a buyer ready, willing, and able to purchase Property at a sales price of at least $ ______(which amount includes the Commission) or any price acceptable to Seller, B. Assist to the extent requested by Seller, in negotiating the terms of and filling out a pre-printed real estate purchase and sale agreement; and C. Comply with all applicable laws in performing its duties hereunder including the Brokerage Relationships in Real Estate Transaction Act, O.C.G.A. § 10- 6A-1 et. Seq. 4. Seller’s Duties. Seller represents that Seller: A. presently has title to Property or has full authority to enter into this Agreement; B. will cooperate with Broker to sell Property to prospective buyers and will refer all inquiries concerning the sale of Property to the Broker during the terms of this agreement; C. will make Property available for showing at reasonable times as requested by Broker; and D. will provide Broker with accurate information regarding Property (including information concerning all adverse material facts pertaining to the physical condition of Property); and E. must fully comply with all state and federal laws. 5. Marketing A. Advertisements: Broker may, in its discretion, advertise Property for sale in any media and may photograph and/or videotape and use the photographs and/or videotapes in connection with Broker's marketing efforts. In connection with the marketing of the Property, Seller authorizes Broker to(b) opt-out of (i) blogging  Yes or  No, and (ii) automated estimated valuation feature  Yes or  No, on virtual office websites. Except as otherwise provided by applicable law, Seller agrees that Broker shall own and control the listings, descriptions, photographs, and other data or intellectual property gathered, compiled, and aggregated by Broker in connection with the marketing and sale of Property by Broker. Seller agrees not to place any advertisements on the property or to advertise the property for sale in any media except with the prior written consent of Broker. Broker is also hereby authorized to place Broker's "For Sale" sign on Property. Broker is authorized to procure buyers to purchase Property in cooperation with other real estate brokers and their affiliated licensees. Broker may distribute listing and sales information (including the sales price) to them and other members of the multiple listing service(s), and said cooperating brokers and their licensees may with permission of Broker (which permission may be granted or denied in the sole discretion of Broker) republish such information on their Internet web sites. Broker and other real estate brokers and their affiliated licensees may show Property without first notifying Seller. B. Lockboxes: A lockbox may be used in connection with the marketing of Property. There have been isolated instances of reported burglaries of homes on which lockboxes have been placed and for which the lockbox has been alleged to have been used to access the home. In order to minimize the risk of misuse of the lockbox, Broker recommends against the use of lockboxes on door handles that can be unscrewed from the outside or on other parts of the home from which the lockbox can be easily removed. Since others will have access to Property, Seller agrees to either remove all valuables or put them in a secure place. C. Multiple Listing Service(s): Seller acknowledges that Broker is a member of the following multiple listing service(s): First Multiple Listing Service, Inc. (FMLS) and Georgia Metro Listing Service (GAMLS). (“Service(s)”). Broker agrees to file this listing with said Service(s) within forty-eight hours after Seller signs the same (excepting weekends, federal holidays and postal holidays). Seller acknowledges that the Service(s) is/are not a party to this Agreement and is/are not responsible for errors or omissions on the part of Seller or Broker. Seller agrees to indemnify Service(s) from and against any and all claims, liabilities, damages or losses arising out of or related to the listing and sale of Property. D. Consent of Seller to be Called: If Seller is on a “Do Not Call List”, Seller expressly consents to any of the above parties calling Seller for any purpose related to the sale of the Property. Seller further acknowledges and agrees that no MLS(s) member or any affiliated licensee of the MLS(s) member shall have any liability for calling the Seller after the expiration or termination of this Agreement. Such calls are hereby expressly consented to by Seller. This paragraph shall survive past the term of this Agreement.

Seller’s Initials 6. Commission. A. Seller agrees to pay Broker at closing a commission of 6 Percent (%) of the final sales price of Property plus $195.00 or $N/A (hereinafter “Commission”) of in the event that during the term of this Agreement 1. Broker procures a buyer ready, willing, and able to purchase Property at the price described above; or 2. Seller enters into a contract for the sale or exchange of Property with any buyer, whether through the efforts of Broker or any other person, including Seller.

B. Broker shall share this Commission with a cooperating broker, if any, who procures the buyer of Property by paying such cooperating broker 3 Percent (%) of the sales price of Property OR $N/A

C. If Seller during the Protected Period, as that term is hereinafter defined, sells or contracts to sell or exchange Property to any buyer who made an offer on, was introduced to, visited, received information on, inquired about, or otherwise learned of the Property during the term of this Agreement, as a result of the efforts of the Broker, then Seller shall pay the commission referenced above to Broker at the closing of the sale or exchange of Property to said buyer. The term “Protected Period” shall refer to the ninety day period following the earlier of either: (a) the expiration of this Agreement; or (b) the date that the Agreement is terminated upon the mutual, written consent of the Broker and Seller. If this agreement is terminated by Seller without the express, written consent of Broker, the Protected Period shall be the time period referenced above plus the number of days that remained on the term of this Agreement at the time it was terminated early without the express, written consent of Broker. For the purposes of this Agreement, the term “buyer” shall include buyer, all members of the buyer’s immediate family, any legal entity in which buyer or any member of buyer’s immediate family owns or controls, directly or indirectly, more than 10% of the shares or interests therein, and any trust or third party who is acting for the benefit of or under the direction or control of any of the above parties. Notwithstanding the above, no listing commission shall be paid to Broker if this Agreement has either expired or been terminated upon the mutual, written consent of Broker and Seller and the Property is sold or contracted to be sold to a prospective buyer by or through another licensed broker with whom Seller has signed an exclusive right to sell listing agreement. The commission rights and obligations set forth herein shall survive the termination or expiration of this agreement. 7. Limits on Broker's Authority and Responsibility. Seller acknowledges and agrees that Broker: A. may show other properties to prospective buyers who are interested in Property; B. shall not be responsible to advise Seller on any matter including but not limited to the following: any matter which could have been revealed through a survey, title search or inspection of Property; the condition of Property, any portion thereof, or any item therein; building products and construction techniques; the necessity or cost of any repairs to Property; mold; hazardous or toxic materials or substances; termites and other wood destroying organisms; the tax or legal consequences of this transaction; the availability and cost of utilities or community amenities; the appraised or future value of Property; any condition(s) existing off Property which may affect Property; the terms, conditions and availability of financing; and the uses and zoning of Property whether permitted or proposed. Seller acknowledges that Brokers are not experts with respect to the above matters and that, if any of these matters or any other matters are of concern to them, they should seek independent expert advice relative thereto. Seller acknowledges that Brokers shall not be responsible to monitor or supervise any portion of any construction or repairs to Property and that such tasks clearly fall outside the scope of real estate brokerage services; C. shall owe no duties to Seller nor have any authority to act on behalf of Seller other than what is set forth in this Agreement; D. may make all disclosures required by law; E. may disclose all information about Property to others; F. shall, under no circumstances, have any liability greater than the amount of the real estate commission paid hereunder to Broker (excluding any commission amount paid to a cooperating real estate broker, if any) ; or, if no real estate commission is paid to Broker, then a sum not to exceed one hundred dollars; and G. shall be indemnified and held harmless by Seller from any and all claims, causes of action, or damages arising out of or relating to: 1. inaccurate and/or incomplete information provided by Seller to a prospective buyer; 2. earnest money handled by anyone other than Broker; or 3. any injury to persons on Property and/or loss of or damage to Property or anything contained therein. 8. Extension. If during the term of this Agreement, Seller and a prospective buyer enter into a real estate sales contract which is not consummated for any reason whatsoever, then the original expiration date of this Agreement shall be extended for the number of days that Property was under contract to said prospective buyer (i.e. the number of days from the date the sales contract was signed until the date it finally is determined that it will not close). 9. Seller’s Property Disclosure Statement. Within three (3) days of the date of this Agreement, Seller agrees to provide Broker with a current, fully executed Seller’s Property Disclosure Statement. Seller warrants and represents that the information with respect to Property as set out in this Agreement is true and correct and that Seller has fully revealed to Broker all pertinent information with respect to Property, including defects therein, if any, and that Broker is hereby authorized to distribute the same to prospective buyers interested in Property. Seller agrees to promptly update any disclosures should any changes occur. A Data Entry form is attached to and made a part of this Agreement by this reference. 10. Required State Law Disclosures. A. Broker agrees to keep confidential all information that Seller asks to be kept confidential by express request or instruction unless the Seller permits such disclosure by subsequent word or conduct or such disclosure is required by law. B. Broker may not knowingly give customers false information. C. In the event of a conflict between Broker’s duty not to give customers false information and the duty to keep the confidences of Seller, the duty not to give customers false information shall prevail. D. Unless specified below, Broker has no other known agency relationships with other parties which would conflict with any interests of Seller (except that Broker may represent other buyers, sellers, landlords, and tenants in buying, selling or leasing property). 11. Disclosure of Potentially Fraudulent Activities. A. To help prevent fraud in real estate transactions, Seller does hereby give Broker permission to report any suspicious, unusual and/or potentially illegal or fraudulent activity (including but not limited to mortgage fraud) to: 1. Governmental officials, agencies and/or authorities and/or 2. Any mortgage lender, mortgage insurer, mortgage investor and/or title insurance company which could potentially be harmed if the activity was in fact fraudulent or illegal. B. Seller acknowledges that Broker does not have special expertise with respect to detecting fraud in real estate transactions. Therefore, Seller acknowledges that: 1. Activities which are fraudulent or illegal may be undetected by Broker and 2. Activities which are lawful and/or routine may be reported by Broker as being suspicious, unusual or potentially illegal or fraudulent.

Seller’s Initials

12. Broker's Policy on Agency. Unless Broker indicates below that Broker is not offering a specific agency relationship, the types of agency relationships offered by Broker are: seller agency, buyer agency, designated agency, dual agency, landlord agency, and tenant agency. The agency relationship(s), if any, NOT offered by Broker is/are the following: None 13. Dual Agency Disclosure. [Applicable only if Broker’s agency policy is to practice dual agency] If Seller and a prospective buyer are both being represented by the same Broker, Seller is aware that Broker is acting as a dual agent in this transaction and consents to the same. Seller has been advised that:

A. In serving as a dual agent, Broker is representing two clients whose interests are or at times could be different or even adverse; B. Broker will disclose all adverse, material facts relevant to the transaction and actually known to the dual agent to all parties in the transaction except for information made confidential by request or instructions from either client which is not otherwise required to be disclosed by law; C. Seller does not have to consent to dual agency and, the consent of the Seller to dual agency has been given voluntarily and the Seller has read and understands the brokerage engagement agreement. E. Notwithstanding any provision to the contrary contained herein, Seller hereby directs Broker, while acting as a dual agent, to keep confidential and not reveal to the other party any information which could materially and adversely affect their negotiating position. F. Broker or Broker’s affiliated licensees will timely disclose to each client the nature of any material relationship with other clients other than that incidental to the transaction. A material relationship shall mean any actually known personal, familial, or business relationship between Broker and a client which would impair the ability of Broker to exercise fair and independent judgment relative to another client. If any party is identified after the Agreement and has a material relationship with Broker, then Broker shall timely provide to Seller a disclosure of the nature of such relationship. 14. Designated Agency Disclosure. [Applicable only if Broker’s agency policy is to practice designated agency] Seller does hereby consent to Broker acting in a designated agency capacity in transactions in which Broker is representing Seller and a prospective buyer. With designated agency, the Broker assigns one or more of its affiliated licensees exclusively to represent the Seller and one or more of its other affiliated licensees exclusively to represent the prospective buyer. 15. GAR Forms. The Georgia Association of REALTORS®, Inc. (“GAR”) makes certain standard real estate forms available to its members. These GAR forms are frequently provided to the parties in real estate transactions by the REALTORS® with whom they are working. No party is required to use any GAR form. Since these forms are generic and written with the interests of multiple parties in mind, they may need to be modified to meet the specific needs of the parties using them. If any party has any questions about his or her rights and obligations under any GAR form he or she should consult an attorney. The parties hereto agree that the GAR forms may only be used in accordance with the licensing agreement of GAR. While GAR forms may be modified by the parties, no GAR form may be reproduced with sections removed, altered or modified unless the changes are visible on the form itself or in a stipulation, addendum, exhibit or amendment thereto. 16. Notices. A. Communications Regarding Real Estate Transactions. Seller acknowledges that many communications and notices in real estate transactions are of a time sensitive nature and that the failure to be available to receive such notices and communications can have adverse legal, business and financial consequences. During the term of this Agreement, Seller agrees to remain reasonably available to receive communications from Broker. B. Notices between Broker and Seller Regarding this Agreement. Seller and Broker agree that communications and notices between them regarding the terms of this Agreement (and excluding real estate transactions with which the parties may be involved) shall be in writing, signed by the party giving the notice, and may be delivered in person or to any address, e-mail address and/or facsimile number to the person to whom the communication or notice is being given specifically set forth in this Agreement. It is the intent of the parties that those means of transmitting notices for which a party has not provided an address or number shall not be used for receiving notices and communications. For example, if a party has not provided an e-mail address in this Agreement, it shall mean that the party is not accepting notices or communications sent by this means. C. Seller Contact Information. The contact information of Seller(s) is set forth below:

Seller Name Business Telephone

Home Telephone

Cell Phone Address for Receiving Notice Facsimile Number

E-Mail Address

Seller Name Business Telephone

Home Telephone

Address for Receiving Notice Cell Phone

Facsimile Number

E-Mail Address

Seller agrees to immediately update Broker of any changes to the above referenced information.

17. Termination. Termination of this Agreement shall not limit Broker’s right to collect any commission earned or owing as of the date of termination or expiration or to which Broker is entitled to collect herein after the termination or expiration of this Agreement. It being expressly agreed that such rights shall survive the termination or the expiration of this Agreement. If this Agreement is terminated early and if the listing of the Property with the Multiple Listing Service(s) is withdrawn with the approval of Broker, Seller shall pay any all applicable Multiple Listing Service fees that may be due and owed on account of or as a result of such early withdrawal or termination and Seller shall pay all costs and expenses reasonably incurred by Broker in connection with marketing the Property up to and through the effective date of termination. 18. Governing Law. This Agreement may be signed via fax and in multiple counterparts and shall be governed by and interpreted pursuant to the laws of the State of Georgia. 19. Entire Agreement. This Agreement constitutes the sole and entire agreement between the parties. No representation, promise or inducement not included in this Agreement shall be binding upon any party hereto. This Agreement and the terms and conditions herein may not be amended, modified or waived except by the written agreement of Seller. The failure of the parties to adhere strictly to the terms and conditions of this Agreement shall not constitute a waiver of the right of the parties later to insist on such strict adherence.

SPECIAL STIPULATIONS: The following Special Stipulations, if conflicting with any exhibit, addendum, or preceding paragraph, shall control: 1. A Seller Information Exhibit which includes Broker’s Affiliated Business Disclosure is attached hereto, incorporated herein by this reference, and made a part of this Exclusive Seller Listing Agreement.

2. ACKNOWLEDGEMENTS. Broker shall have the right, in its discretion, to increase or decrease the offer of compensation to cooperating brokers and Seller will be notified of any such change; provided, however, that Seller shall not be obligated under this agreement to pay more than the amounts set forth herein. Georgia law permits a cooperating broker to represent the interests of the buyer even though the Seller compensates that broker. Seller and Broker acknowledge that this Agreement does not guarantee a sale. If Coldwell Banker residential Brokerage is acting as escrow agent in your transaction, we will deposit funds received on your behalf (“Deposit”) in a non-interest bearing account (“Account”) at Wachovia Bank (“Bank”), a federally-chartered bank that is insured by the Federal Deposit Insurance Corporation (“FDIC”). FDIC deposit insurance coverage applies to a maximum amount of $250,000 per depositor for deposits held in the same legal ownership category at each bank (“FDIC Limit”). For example, the Deposit will be combined with any individual accounts held directly by you at the Bank. You are responsible for monitoring the total amount of deposits that you own, directly or indirectly, in the Bank. If you have questions about FDIC deposit insurance, contact your financial or legal advisors or go to www.fdic.gov/deposit/deposits/index/html We do not guarantee the solvency of any bank into which funds are deposited and we assume no liability for any loss you incur due to the failure, insolvency or suspension of operations of any bank or the $250,000 FDIC limit. The Property will be offered to any person without regard to race, color, religion, sex, handicap, familial status, national origin or any other status or class protected by law.

3. Referrals. (a) Seller (i) authorizes Broker to refer Seller to another real estate licensee for brokerage or relocation services not related to the Property (ii) acknowledges that Broker may receive a referral fee from that licensee if Seller consummates a real estate transaction with that license. Referral fees may vary, but typically range from 10% to 40% of the transaction side being referred and will be paid to Broker by the other licensee from the other licensee’s commission.

(b) If Seller was referred to Broker by another real estate licensee, Broker is paying the following referral fee from its commission:

Recipient % OR $ Referral Fee

4. Indemnification: Seller agrees to indemnify Broker and hold Broker harmless from losses, damages, costs and expenses of any nature, including attorney's fees, and from liability to any person, that Broker incurs because of (a) Seller's negligence, representations, omissions, actions, or inactions, (b) any loss or theft relating to the use of a lock box or from Seller's failure to remove or secure valuables during Open Houses, (c) the existence of undisclosed material facts about the Property, or (d) a court or arbitration decision that a broker who was not compensated in connection with a transaction is entitled to compensation from Broker.

Seller’s Initials Agent FMLS# CBRB# BY SIGNING THIS AGREEMENT, SELLER ACKNOWLEDGES THAT: (1) SELLER HAS READ ALL PROVISIONS AND DISCLOSURES MADE HEREIN; (2) SELLER UNDERSTANDS ALL SUCH PROVISIONS AND DISCLOSURES AND HAS ENTERED INTO THIS AGREEMENT VOLUNTARILY; AND (3) SELLER IS NOT SUBJECT TO A CURRENT LISTING AGREEMENT WITH ANY OTHER BROKER.

RECEIPT OF A COPY OF THIS AGREEMENT IS HEREBY ACKNOWLEDGED BY SELLER. The above Agreement is hereby accepted, O’clock .m, on the Day of 20 .

COLDWELL BANKER RESIDENTIAL

Broker

1735 BUFORD HWY STE 125

Address

CBRB17 MLS Office Code

H-59730 Broker Firm License Number

770-889-3051 Broker’s Telephone #

678-328-5199 Facsimile Number

Seller’s Signature

Print or Type Name

By:______Broker or Broker’s Affiliated Licensee

Print or Type Name

Agent’s Georgia Real Estate License Number

E-Mail Address

Seller’s Initials

AGENT FMLS Seller Information Exhibit CBRB#

Property Address Concierge Services Coldwell Banker Residential Brokerage offers Concierge services to our sellers. For assistance, contact our Concierge at 404-705-1734. PHH Home Loans, LLC d/b/a Coldwell Banker Home Loans: Coldwell Banker Home Loans can assist the Seller with financing needs anywhere in the country. Seller may request information about special mortgage financing programs and free pre-approval services for their next home purchase by calling ______. Regency Title Services: Seller requests that the closing on this property be conducted by the firm Weissman, Nowack, Curry & Wilco, P.C. NRT Insurance Agency, Inc. Coldwell Banker Residential Brokerage Insurance Agency, Inc. provides insurance agency services for homeowners. Request information by calling 1-888-717-1776. Coldwell Banker Home Protection Plan: A home warranty gives the seller a competitive edge in the marketplace. Seller acknowledges that the Coldwell Banker Home Protection Plan has been explained to them and hereby: Desires to provide home warranty to Buyer at closing thereby providing coverage for repairs and replacement on covered systems and appliances for Seller during listing period.

Seller desires optional HVAC coverage at an additional cost. Seller declines Coldwell Banker Home Protection Plan. AFFILIATED BUSINESS ARRANGEMENT DISCLOSURE STATEMENT To: Consumer From: Coldwell Banker Residential Brokerage Thank you for contacting us, your local Coldwell Banker Residential Brokerage office (hereinafter Broker), in connection with the purchase or sale of a home or other property. This is to give you notice that Broker has a business relationship with the companies listed in this Statement, in that each of the companies is wholly or partially owned either directly or indirectly by NRT LLC or by Realogy Corporation. Realogy Corporation indirectly wholly owns NRT LLC, a parent company of your local Broker and other brokerage offices throughout the nation. Realogy Corporation also owns the franchisor of the BETTER HOMES & GARDENS® COLDWELL BANKER®, COLDWELL BANKER COMMERCIAL®, CENTURY 21®, ERA® and SOTHEBY’S INTERNATIONAL REALTY® systems. Because of these relationships, the referral of business to these companies may provide us, our employees or other related parties noted herein a financial or other benefit. In connection with providing real estate brokerage services, Broker may receive a commission or a cooperative brokerage referral fee for a referral to another real estate brokerage company (which is typical in the real estate brokerage industry); however, this will not affect the amount you pay to purchase or sell a property. We have set forth below the full range of services that these companies provide, along with an estimate of the range of charges generally made for these services. You are NOT required to use the listed companies 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 PHH HOME LOANS, LLC D/B/A COLDWELL BANKER Loan origination fee2 HOME LOANS Loan discount fee/points Provides a full range of residential first mortgage loan products and services. U.S. NATIONAL 1031 EXCHANGE Qualified Intermediary fee Acts as a qualified intermediary for IRC 1031 Tax Deferred Exchanges.

Seller’s Initials REGENCY TITLE COMPANY LLC Title Commitment (if applicable) 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. Lender’s/Owner’s Title Insurance NRT INSURANCE AGENCY, INC. Homeowner’s Insurance Premium Provides insurance agency services for homeowner’s insurance. 1. Actual charges may vary according to the particular circumstances underlying the transaction, including the home value, coverage and limits, other requested terms and services, unusual market conditions, government regulations, property location and features, and other similar factors. Rates may not be the lowest available and are subject to change. For a free, no obligation quote, please contact the company directly. Where required by state law, current rates for insurance are filed with the applicable state agency, and depending upon the circumstances, may vary from the rates shown above. 2. There are other charges imposed in connection with mortgage loans. In addition, a lender may require the use of other service providers, including but not limited to an attorney, credit reporting agency or real estate appraiser chosen to represent the lender’s interest. If you apply to any of these companies for a loan, you will receive Good Faith Estimate within 3 days of submission of your loan application which will provide you with detailed information of the anticipated charges associated with your loan. 3. The loan/discount fee/points are affected by the loan interest rate.

Although not affiliated business arrangements, please also note the following: certain Brokers market the Coldwell Banker Home Protection Plan (provided by American Home Shield Corporation) as well as other products and services. Broker, its employees or its affiliate(s) may receive a financial or other benefit in connection with the products or services described herein. Acknowledgement of Receipt of Disclosure I/We have received the Affiliated Business Arrangement Disclosure Statement from Broker and understand that Broker may refer me/us to the settlement service providers listed in this Statement. Broker, its employees or its affiliate(s) may receive a financial or other benefit as the result of that referral.

Name Date Name Date BETTER Homes & GARDENS® and the BETTER HOMES & GARDENS REAL ESTATE logo are registered trademarks of Meredith Corporation licensed to Better Homes & Gardens Real Estate LLC. COLDWELL BANKER® and COLDWELL BANKER COMMERCIAL ® are registered trademarks licensed to Coldwell Banker Real Estate Corporation. ERA ® is a registered trademark licensed to ERA Franchise Systems, Inc. CENTURY 21 ® is a registered trademark licensed to Century 21 Real Estate Corporation. SOTHEBY’S INTERNATIONAL REALTY ® is a registered trademark licensed to Sotheby’s International Realty Affiliates, Inc. An Equal Opportunity Company. Equal Housing Opportunity. Owned and Operated by NRT LLC. © 2009 NRT LLC. All rights reserved

Seller’s Signature

Print or Type Name

Seller’s Initials