The Medical – Dental – Licensed Real Estate Specialist”

Practice Sales – Commercial Real Estate – Office Space – Appraisals

CONFIDENTIALITY NON-DISCLOSURE FORM (DENTAL)

Acknowledgment, Agreement and Record of Showing

ALL PRACTICES LISTED OR INTRODUCED TO BY DOCTOR’S CHOICE COMPANIES, INC.

Business Name

Doctor's Choice Companies, Inc.

J Kenny Jones/President-Broker

I the undersigned prospective purchaser(s) hereby acknowledge receipt of confidential information about the business here described introduced to me by Doctor's Choice Companies, Inc. (Exclusive Broker and Procuring Broker)

Please, do not contact owner, employees, suppliers or other brokers.

In consideration of your having provided the above information, I hereby agree, (1) not to reproduce or divulge such information to any person without owner's written consent. (2) I understand that disclosure to any other person's of the availability of the practice may cause great harm to the seller. (3) To conduct all further inquiries into the above opportunities exclusively through the office of the above named Broker, to maintain such Confidentiality. (4) To not contact the seller or enter the sellers practice without permission directly from the seller.

I understand that the Broker has entered into a listing agreement or contract with the owner or their authorized agent to represent the above listed Business which provides for commission payment to Broker from Seller.

Buyer agrees to indemnify and hold harmless Broker and those relying thereupon for damages resulting from the inaccuracy of said information and from Seller's failure to disclose any facts materially affecting the value or desirability of the property and Business.

TRANSACTION BROKER NOTICE

Florida Real Estate Licensees who desire to operate as a Transaction Broker are required by Section 475.25(1)(q) 3, Florida Statutes, to give written notice to all parties to the real estate transaction. The purpose of the TRANSACTION BROKER NOTICE is to place the parties on notice that the licensee will be operating as a Transaction Broker and to describe the licensee’s role as a Transaction Broker.

A licensee who facilitates a brokerage transaction between a Seller and a Buyer without representing either party as an agent known as a Transaction Broker. A Transaction Broker has no fiduciary duty to either party except the duties of accounting and to use skill, care and diligence.

A Transaction Broker is REQUIRED to treat the seller and buyer with honesty and fairness, and shall disclose all known facts materially affecting the value of the property to the Seller and Buyer.

The TRANSACTION BROKER NOTICE has been adopted by the Florida Real Estate Commission and is required by Rule 61 J2-10.037 of the rules of the commission.

BPR 70-01-001.025

PLEASE READ AND INITIAL____________________

________________________________ _____________________________

Authorized Representative (Print Name Here) Authorized Representative (Signature)

________________________________

Date

Company: ____________________________

Complete Mailing Address: _______________________________________________

(Home or Office – Circle One)

Buyer or Seller: _______________________

Area of Interest (Exp. Counties, Cities): ___________________________________________

Phone Number to call you at:

Office: ____________________

Cell: ____________________

Home: ____________________

Please Fax to Doctor’s Choice: 561-746-9601