Disclosure of Financial Interest PDF

DISCLOSURE OF FINANCIAL INTEREST This form recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association of Realtors® (PAR). 1 BROKER DFI Keller Williams Platinum Realty (Company)_______________________________________________________________________________...

DISCLOSURE OF FINANCIAL INTEREST This form recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association of Realtors® (PAR). 1 BROKER DFI Keller Williams Platinum Realty (Company)___________________________________________________________________________________________ 2 LICENSEE(S)_________________________________________________________________________________________________ 3 CONSUMER__________________________________________________________________________________________________ 4 Note: This form is designed to satisfy the requirements of §606.1(13) of the Real Estate Licensing and Registration Act. This form should used whenever a Licensee first recommends that a consumer purchase a service in which the Licensee or an affiliated licensee has 6 a financial interest or when the Licensee first learns that a consumer will be purchasing a service in which the Licensee or an affiliated 7 Licensee has a financial interest. 5 be 8A settlement-related service may include financial, title transfer and preparation, insurance, construction, repair, inspection, or any similar Purchasing a service from any of the following providers will result in payment to, or financial gain by, the Licensee or by another 10 member of the brokerage. You are not required to purchase any recommended service. 9 ­service. 11 Service Home Services, LLC Provider:__Platinum _______________________________________________________________________________________________ Provider:__CMG _______________________________________________________________________________________________ Home Loans 13 Service Provider:__ Safeguard Insurance _______________________________________________________________________________________________ 14 Service Provider:__ AHS/ HSA/ Cinch / America's Preferred Home Warranties _______________________________________________________________________________________________ 15 Service Provider:_________________________________________________________________________________________________ 16 Service Provider:_________________________________________________________________________________________________ 12 Service 17 THIS DISCLOSURE OF FINANCIAL INTEREST MUST BE MADE AT THE TIME ANY SERVICE PROVIDER IS RECOMMENDED. 18 CONSUMER_____________________________________________________________________ DATE_____________________ DATE_____________________ 20 CONSUMER_____________________________________________________________________ DATE_____________________ 19 CONSUMER_____________________________________________________________________ 21 22 Williams Platinum Realty BROKER (Company Name)__Keller ___________________________________________________________________________________ ACCEPTED BY________________________________________________________________ DATE_____________________ COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORS® 1999 11/99