Dual Agency Informed Consent Form — Mississippi Edition Template

Dual agency — one brokerage (or one agent) representing both buyer and seller in the same transaction — is the most heavily regulated conflict of interest in residential real estate. A handful of states ban it outright; the rest permit it only with the informed written consent of both parties, obtained after meaningful disclosure of what the parties are giving up. Get the consent wrong and the consequences stack fast: license discipline, commission forfeiture, and rescission or damages claims grounded in breach of fiduciary duty. Courts have long treated undisclosed dual agency as a fiduciary breach that can void the broker's right to any commission.

This 4-page Informed Consent form does the disclosure properly rather than minimally. It explains in plain language what agency representation normally includes (undivided loyalty, full disclosure, advocacy on price and terms); exactly which duties are limited in dual agency (the agent cannot advocate for either side on price, cannot disclose one party's willingness to pay more or accept less, cannot share confidential negotiating positions); what duties remain intact (honesty, disclosure of material property facts, accounting, confidentiality); and the designated agency alternative where the brokerage appoints separate agents for each party, where state law permits. Both buyer and seller sign separate acknowledgment and consent blocks, with transaction-specific identification and timing language confirming consent was obtained before or at the point dual agency arose.

The 50-state notes summarize the landscape: consent-based regimes (e.g., New York's RPL § 443 disclosure form with dual agency consent), designated agency states, transaction-brokerage states that replace agency entirely, and the states where dual agency is prohibited. This template supplements — and in states with mandatory statutory forms, accompanies — the state-prescribed disclosure. Not a substitute for your state's required form where one exists.

About this Mississippi Edition: Drafted around the Mississippi Real Estate Brokers License Law (Miss. Code Ann. § 73-35-1 et seq.) and the Mississippi Real Estate Commission's agency-disclosure rules, under which licensees deliver the MREC "Working With a Real Estate Broker" disclosure at first substantive contact and dual agency is lawful only with the informed written consent of both parties — the dual-agency form, listing agreement and buyer-representation agreement are built on that consent-and-confirmation regime, with all compensation flowing through the Responsible Broker. The seller disclosure form tracks the Property Condition Disclosure Statement required by Miss. Code Ann. § 89-1-501 et seq., and the contract forms rely on the Mississippi statute of frauds (§ 15-3-1) and the Mississippi Uniform Electronic Transactions Act (§ 75-12-1 et seq.) alongside federal E-SIGN. Because Mississippi has no general commercial broker lien statute, the commission and referral forms rely on contract remedies rather than lien rights, and Mississippi terminology (Responsible Broker, chancery court, Chancery Clerk, deeds of trust, attorney closings) is used throughout.