(c) The confirmation required by subdivisions (a) and (b) shall be in the following form:
_____________________________ is the agent of (check one):
(Name of Listing Agent) ( ) the seller exclusively; or ( ) both the buyer and seller.
__________________________________________________________________ (Name of Selling Agent if not the same as the Listing Agent) is the agent of (check one):
() the buyer exclusively; or ( ) the seller exclusively; or ( ) both the buyer and seller.