BUYER NAME:_________________________________________
BUYER ADDRESS:________________________________________________________
BUYER PHONE #:_____________________ AGENT PHONE ____________________________

It is understood and agreed that the Broker commission structure will be based on the stated Terms and Conditions of sale of the above referenced auction and that said commission will be based on the successful high bid (the Hammer Price)* on the property. Commission is to be paid only to the licensed Real Estate Broker named herein upon closing, where permitted by law, if the above named "Buyer" is the high bidder at auction and the subject property is sold to the same buyer**. Only the first registration of a prospective bidder received will be honored. No Broker Acknowledgement Forms will be accepted at the auction site.

________________________ Broker Signature

Date_________

_______________________ Agent Signature

Date_____________

________________________ Broker Signature

Date_________

_______________________ Agent Signature

Date_____________

_____________________________________ Broker Name Printed

________________________________________ Agent Name Printed

Real Estate License No.__________________

Real Estate License No.____________________

_____________________________________Date_____________
Prospective Buyer(s) Signature

RECEIVED BY:
Matthew S. Hurley Auction Co. Inc.
BY_______________________________Date_____________Time:____________
*High bid is defined as purchase price or the "Hammer Price".
**Broker /agent certifies that neither broker/agent, his/her employees, agents, nor any member(s) of his/her immediate family, is or will be the buyer.

ALL BROKER PARTICIPATION FORMS MUST BE
RECEIVED 48 HOURS PRIOR TO SHOWINGS OR AUCTION!