SELECTED DEALER AGREEMENT
EXHIBIT
1.1
Ladies
and Gentlemen:
United
Development Funding III, L.P. (the “Partnership”), a Delaware limited
partnership of which UMTH Land Development, L.P., a Delaware limited
partnership, serves as the general partner (the “General Partner”), is offering
for public sale a maximum of 17,500,000 units of limited partnership interest,
including 5,000,000 units issuable pursuant to the Partnership’s distribution
reinvestment plan (collectively, the “Units”), to be issued and sold for an
aggregate purchase price of $350,000,000. There shall be a minimum
purchase by any one person of 250 Units (except for purchases through individual
retirement accounts or other qualified accounts, as indicated in the Prospectus
(defined below), or in any letter or memorandum from the Partnership to you
(the
“Dealer”)). Terms not defined herein shall have the same meaning as
in the Prospectus. In connection therewith, the Partnership invites
you to participate in the distribution of Units in the Partnership subject
to
the following terms:
I. The
Offering
A
registration statement with respect to the Partnership has been prepared by
the
Partnership in accordance with applicable requirements of the Securities Act
of
1933, as amended (the “Securities Act”), and the applicable rules and
regulations of the Securities and Exchange Commission (the “SEC”) promulgated
thereunder covering the Units (the “Rules and Regulations”). Such
registration statement was initially filed with the SEC on or about August
26,
2005. Copies of such registration statement and each amendment
thereto have been or will be delivered to the Dealer. (The
registration statement and prospectus contained therein, as finally amended
and
revised at the effective date of the registration statement, are respectively
hereinafter referred to as the “Registration Statement” and the “Prospectus,”
except that if the Prospectus first filed by the Partnership pursuant to Rule
424(b) under the Securities Act shall differ from the Prospectus, the term
“Prospectus” shall also include the Prospectus filed pursuant to Rule
424(b).)
The
Dealer hereby agrees to use its best efforts to sell the Units for cash on
the
terms and conditions stated in the Prospectus. Nothing in this
Selected Dealer Agreement (the “Agreement”) shall be deemed or construed to make
the Dealer an association or other separate entity or employee, agent,
representative or partner of the Partnership, the General Partner or with other
dealers, and the Dealer is not authorized to act for the General Partner, the
Partnership or any other dealer of the Units, or to make any representations
on
its behalf except as set forth in the Prospectus and such other printed
information furnished to the Dealer by the Partnership to supplement the
Prospectus (the “Supplemental Information”). The Dealer will be
responsible for its share of any liability or expense based on any claim to
the
contrary. The Partnership shall not be liable to the Dealer, except
for obligations expressly assumed in this Agreement and any liabilities under
the Securities Act, and no obligations on the part of the Partnership will
be
implied or inferred from this Agreement. The foregoing provision
shall not be deemed a waiver of any liability imposed under the Securities
Act. This Agreement will confirm the understanding and agreement
between the Partnership and you, the Dealer, with respect to your participation
in the offering and sale of the Units on the terms and conditions and subject
to
the representations and warranties hereinafter set forth.
II. Submission
of Orders
Until
such time as the Partnership has received and accepted subscriptions for at
least $1,000,000 of Units and released the proceeds from such subscriptions
from
escrow (or such greater amount as may be applicable in respect of any greater
escrow in respect of subscribers from any state), those persons who purchase
Units will be instructed by the Dealer to make their checks payable to “United
Development Funding III, L.P. Escrow Account.”
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Thereafter,
in the discretion of the General Partner upon notice to the Dealer, those
persons who purchase Units will be instructed by the Dealer to make their checks
payable to “United Development Funding III, L.P.” If the Dealer
receives a check not conforming to the foregoing instructions, the Dealer shall
return such check directly to such subscriber not later than the end of the
next
business day following its receipt. Checks received by the Dealer
that conform to the foregoing instructions shall be transmitted for deposit
pursuant to one of the methods in this Article II. The Partnership
may authorize the Dealer, if the Dealer is a “$250,000 broker-dealer,” to
instruct its customers to make its checks for Units subscribed for payable
directly to the Dealer, in which case the Dealer will collect the proceeds
of
the subscriber’s checks and issue a check for the aggregate amount of the
subscription proceeds made payable to the order of the escrow agent, or if
the
Partnership has received and accepted subscriptions for at least $1,000,000
of
Units and released the proceeds from such subscriptions from escrow, made
payable to the order of the Partnership.
The
Dealer shall forward the subscription documents and the checks to the
Partnership by noon of the next business day following receipt of the
subscription documents and the checks. If, at the time of the
Partnership’s receipt of the subscription documents and checks, the Partnership
has not received and accepted subscriptions for at least $1,000,000 of Units
and
released the proceeds from such subscriptions from escrow, the Partnership
undertakes to submit each check to the escrow agent on the same day it is
received by the Partnership from the Dealer. The Dealer shall insure
that any such submissions of checks by the Partnership to the escrow agent
occur
in accordance with the provisions of the previous sentence. If
requested by the Partnership, the Dealer shall obtain from subscribers for
the
Units, other documentation reasonably deemed by the Partnership to be required
under applicable law or as may be necessary to reflect the policies of the
Partnership. Such documentation may include, without limitation,
subscribers’ written acknowledgement and agreement to the privacy policies of
the Partnership.
III. Pricing
Units
shall be offered to the public at the offering price of $20.00 per Unit, subject
to the terms and pricing information provided in the Prospectus and the
Distribution Reinvestment Plan attached thereto. Except as otherwise
indicated in the Prospectus or in any letter or memorandum sent to the Dealer
by
the Partnership, a minimum initial purchase of 250 Units is
required. Except as otherwise indicated in the Prospectus, additional
investments may be made in cash in minimal increments of at least 50
Units. The Units are nonassessable, and limited partners will not be
required to contribute additional sums to the capital of the
Partnership. The Dealer hereby agrees to place any order for the full
purchase price.
IV. Dealers’
Commissions and Fees
Except
for discounts described in or as otherwise provided in the “Plan of
Distribution” section of the Prospectus, the Dealer’s selling commission is the
percentage of the gross proceeds of Units sold by it pursuant to the terms
of
this Agreement and accepted and confirmed by the General Partner or the
Partnership set forth as “selling commissions” in the “Plan of Distribution –
Compensation We Will Pay for the Sale of Our Units” and “Plan of Distribution –
Units Purchased by Affiliates” sections of the Prospectus, which commissions
will be paid by the Partnership. A sale of Units shall occur if and
only if a transaction has closed pursuant to all applicable offering and
subscription documents. In addition, as set forth in the Prospectus,
the Partnership will reimburse the Dealer for certain due diligence fees and
UMTH Funding Services, L.P. (“UMTH Funding”), an affiliate of the General
Partner, may reallow to the Dealer a portion of its marketing support fee for
direct marketing support, each up to the limits set forth in the “Plan of
Distribution” section of the Prospectus. Additionally, in the event
that Dealer
employs wholesalers who are dual employees of Dealer and UMTH Funding or
otherwise, the Dealer’s wholesaling fee is the percentage of the gross offering
proceeds of Units sold through such wholesalers pursuant to the terms of this
Agreement and accepted and confirmed by the General Partner or the Partnership
set forth as “wholesaling fees” in the “Plan of Distribution – Compensation We
Will Pay for the Sale of Our Units” and “Plan of Distribution – Units Purchased
by Affiliates” sections of the Prospectus, which fees will be paid by the
Partnership. The Dealer hereby agrees that, if it is a NASD
member, it will not re-allow all or any part of the compensation provided for
in
this Section IV to any person who is not also a member of the NASD.
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The
Dealer acknowledges and agrees that no commissions, payments or amount
whatsoever will be paid to the Dealer unless or until the gross proceeds of
the
Units sold are disbursed to the Partnership pursuant to the Escrow Agreement
between the Partnership and Coppermark Bank, N.A. Until the Required
Capital, as defined in the Escrow Agreement, is obtained, investments will
be
held in escrow and, if the Required Capital is not obtained, investments will
be
returned to the investors in accordance with the Prospectus.
The
parties hereby agree that the foregoing commission is not and will not be in
excess of the usual and customary distributors’ or sellers’ commission received
in the sale of securities similar to the Units and that Dealer’s interest in the
offering is limited to such commission from the Partnership and the Dealer’s
indemnity referred to in Article XIII of this Agreement. Any payment
to the Dealer will be payable only with respect to transactions lawful in the
jurisdictions where such transactions occur.
V. Payment
The
commissions to be paid to the Dealer hereunder with respect to any subscriptions
that are obtained by the Dealer and accepted by the Partnership and the General
Partner shall be paid to the Dealer within 10 days after those subscribers
are
admitted as limited partners in the Partnership.
VI. Right
to Reject Orders or Cancel Sales
All
orders, whether initial or additional, are subject to acceptance by and shall
only become effective upon confirmation by the General Partner and the
Partnership, and the General Partner and the Partnership reserve the right
to
reject any order for any or no reason. All subscriptions will be
accepted or rejected by the General Partner and the Partnership within
approximately ten days after the Partnership’s receipt of all necessary
documents relating thereto. Issuance and delivery of the Units will
be made only after actual receipt of payment therefore, and upon acceptance
of a
subscription, the General Partner or the Partnership will provide confirmation
of that acceptance to the Dealer and to the subscriber. If any check
is not paid upon presentment, or if the Partnership is not in actual receipt
of
clearinghouse funds or cash, certified or cashier’s check or the equivalent in
payment for the Units within 15 days of sale, the Partnership reserves the
right
to cancel the sale without notice. In the event an order is rejected,
canceled or rescinded for any reason, the Dealer agrees to return to the
Partnership any commission theretofore paid with respect to such
order.
VII. Prospectus
and Supplemental Information
The
Dealer is not authorized or permitted to give and will not give, any information
or make any representation concerning the Units except as set forth in the
Prospectus and the Supplemental Information. The Partnership will
supply the Dealer with reasonable quantities of the Prospectus, any supplements
thereto and any amended Prospectus, as well as any Supplemental Information,
for
delivery to investors, and the Dealer will deliver a copy of the Prospectus
and
all supplements thereto and any amended Prospectus to each investor to whom
an
offer is made prior to or simultaneously with the first solicitation of an
offer
to sell the Units to an investor. The Dealer agrees that it will not
send or give any supplements thereto and any amended Prospectus to that investor
unless it has previously sent or given a Prospectus and all supplements thereto
and any amended Prospectus to that investor or has simultaneously sent or given
a Prospectus and all supplements thereto and any amended Prospectus with such
Supplemental Information. The Dealer agrees that it will not show or
give to any investor or prospective investor or reproduce any material or
writing that is supplied to it by the Partnership and marked “dealer only” or
otherwise bearing a legend denoting that it is not to be used in connection
with
the sale of Units to members of the public. The Dealer agrees that it
will not use in connection with the offer or sale of Units any material or
writing that relates to another program supplied to it by the Partnership
bearing a legend that states that such material may not be used in connection
with the offer or sale of any securities other than the program to which it
relates. Dealer further agrees that it will not use in connection
with the offer or sale of Units any materials or writings that have not been
previously approved by the Partnership. The Dealer agrees, if the
Partnership so requests, to furnish a copy of any revised preliminary Prospectus
to each person to whom it has furnished a copy of any previous preliminary
Prospectus, and further agrees that it will itself mail or otherwise deliver
all
preliminary and final Prospectuses required for compliance with the provisions
of Rule 15c2-8 under the Securities Exchange Act of 1934, as amended (the
“Exchange Act”). In offering and selling Units, the Dealer agrees to
comply with all the applicable requirements under the Securities Act and the
Exchange Act.
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VIII. License
and Association Membership
The
Dealer’s acceptance of this Agreement constitutes a representation to the
Partnership that the Dealer is a properly registered or licensed broker-dealer,
duly authorized to sell Units under federal and state securities laws and
regulations and in all states where it offers or sells Units, and that it is
a
member in good standing of the National Association of Securities Dealers,
Inc.
(the “NASD”). This Agreement shall automatically terminate if the
Dealer ceases to be a member in good standing of such association, or in the
case of a foreign dealer, so to conform. The Dealer agrees to notify
the Partnership immediately if it ceases to be a member in good standing, or
in
the case of a foreign dealer, so to conform. The Dealer also hereby
agrees to comply with the Conduct Rules of the NASD, including but not limited
to Rules 2730, 2740, 2420 and 2750, and the provisions in Rule 2810 that
apply to Direct Participation Programs.
IX. Anti-Money
Laundering Compliance Programs
The
Dealer represents to the Partnership that it has established and implemented
anti-money laundering compliance programs in accordance with applicable law,
including applicable NASD rules, SEC rules and the USA PATRIOT Act of 2001,
reasonably expected to detect and cause the reporting of suspicious transactions
in connection with the sale of Units of the Partnership.
X.
Limitation of Offer
The
Dealer will offer Units only to persons who meet the financial qualifications
set forth in the Prospectus or in any suitability letter or memorandum sent
to
it by the Partnership and will only make offers to persons in the states in
which it is advised in writing that the Units are qualified for sale or that
such qualification is not required. In offering Units, the Dealer
will comply with the provisions of the NASD Conduct Rules, including the
provisions in Rule 2810 that apply to Direct Participation Programs, set forth
in the NASD Manual, as well as all other applicable rules and regulations
relating to suitability of investors, including without limitation, the
provisions of Article III.C. of the Statement of Policy Regarding Real Estate
Programs of the North American Securities Administrators Association,
Inc.
XI. Representations
and Warranties of the Partnership
The
Partnership hereby represents and warrants to the Dealer that:
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(a)
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The
Partnership has been duly and validly organized and formed as a limited
partnership under the laws of the state of Delaware, with the power
and
authority to conduct its business as described in the
Prospectus. The Partnership has obtained all necessary
authorizations, approvals and orders of and from all governmental
regulatory officials and bodies authorizing it to own its properties
and
conduct its business as described in the Registration Statement and
the
Prospectus; provided, however, that the foregoing representation
is only
to the best knowledge of the Partnership as to any material penalty
or
other material liability.
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(b)
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The
Registration Statement and Prospectus comply with the Securities
Act and
the Rules and Regulations and do not contain any untrue statements
of
material facts or omit to state any material fact required to be
stated
therein or necessary in order to make the statements therein not
misleading; provided, however, that the foregoing provisions of this
Article XI(b) will not extend to such statements contained in or
omitted
from the Registration Statement or Prospectus as are primarily within
the
knowledge of the Dealer or are based upon information furnished by
the
Dealer in writing to the Partnership specifically for inclusion
therein.
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(c)
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The
Partnership intends to use the funds received from the sale of the
Units
as set forth in the Prospectus.
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(d)
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No
consent, approval, authorization or other order of any governmental
authority is required in connection with the execution or delivery
by the
Partnership of this Agreement or the issuance and sale by the Partnership
of the Units, except such as may be required under the Securities
Act or
applicable state securities laws.
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(e)
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There
are no actions, suits or proceedings pending or, to the knowledge
of the
Partnership, threatened against the Partnership at law or in equity
or
before or by any federal or state commission, regulatory body or
administrative agency or other governmental body, domestic or foreign,
that will have a material adverse effect on the business or property
of
the Partnership.
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(f)
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The
execution and delivery of this Agreement, the consummation of the
transactions herein contemplated and compliance with the terms of
this
Agreement by the Partnership will not conflict with or constitute
a
default under any charter, bylaw, indenture, mortgage, deed of trust,
lease, rule, regulation, writ, injunction or decree of any government,
governmental instrumentality or court, domestic or foreign, having
jurisdiction over the Partnership, except to the extent that the
enforceability of the indemnity and/or contribution provisions contained
in Article XIII of this Agreement may be limited under applicable
securities laws.
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(g)
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The
Partnership has full legal right, power and authority to enter into
this
Agreement and to perform the transactions contemplated hereby, except
to
the extent that the enforceability of the indemnity and/or contribution
provisions contained in Article XIII of this Agreement may be limited
under applicable securities laws.
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(h)
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At
the time of the issuance of the Units, the Units will have been duly
authorized and validly issued, and upon payment therefor, will be
fully
paid and nonassessable and will conform to the description thereof
contained in the Prospectus, subject to the requirement that the
limited
partners do not participate in the management or control of the business
of the Partnership.
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XII. Records
At
all
times during the term of this Agreement and for a period of five years
thereafter, the Dealer shall keep, or cause to be kept, and shall make available
to the Partnership, information establishing that each investor in the Units
meets the suitability standards employed in connection with the offer and sale
of Units, and a representation of each investor that he or she is purchasing
for
his or her own account or for the account of another who meets such suitability
standards.
XIII. Indemnification
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(a)
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The
Partnership agrees to indemnify and hold the Dealer harmless against
any
losses, claims, damages or liabilities, joint or
several:
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(i)
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to
which the Dealer may become subject under applicable law, insofar
as such
losses, claims, damages or liabilities (or actions in respect thereof)
are
based upon any untrue statement of any material fact contained in
the
Prospectus or any amendment or supplement thereto, or in any supplemental
sales literature furnished by the Partnership, or that are based
upon the
omission or alleged omission to state therein a material fact required
to
be stated therein or necessary to make the statements therein, in
light of
the circumstances under which they were made, not
misleading;
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(ii)
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to
which the Dealer may become subject due to the misrepresentation
by the
Partnership of material facts in connection with the sale of the
Units
unless the misrepresentation of such material facts was the direct
result
of misleading information provided to the Partnership by any dealer
of the
Units; or
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(iii)
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to
which the Dealer may become subject as a result of any breach by
the
Partnership of the representations and warranties contained in this
Agreement.
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The
Partnership will reimburse the Dealer for any legal or other expenses reasonably
incurred in connection with investigating or defending any such loss, claim,
damage or liability (or actions in respect thereof); provided, however, that
the
Partnership shall not be liable in any such case to the extent that any such
loss, claim, damage or liability arises out of or is based upon any untrue
statement or alleged untrue statement or omission or alleged omission made
in
the Prospectus, any amendment or supplement or any sales literature, in reliance
upon and in conformity with written information furnished to the Partnership
by
the dealer specifically for use in the preparation
thereof. Notwithstanding the foregoing, the Partnership will not
indemnify the Dealer from any liabilities incurred by the Dealer arising under
federal and state securities laws unless (A) there has been a successful
adjudication on the merits of each count involving alleged securities law
violations as to the Dealer seeking indemnification; (B) such claims have been
dismissed with prejudice on the merits by a court of competent jurisdiction
as
to the Dealer seeking indemnification; or (C) a court of competent jurisdiction
approves a settlement of the claims against the Dealer seeking indemnification
and finds that indemnification of the settlement and related costs should be
made.
In
addition, prior to seeking a court approval for indemnification, the Dealer
is
required to apprise the court of the position of the Securities and Exchange
Commission and any state securities regulatory authority in which the Units
were
offered or sold with respect to indemnification for securities
violations. Insofar as indemnification for liabilities arising under
the Securities Act of 1933, as amended, may be permitted for the Dealer, the
Dealer has been informed that in the opinion of the Securities and Exchange
Commission such indemnification is against public policy as expressed in the
Securities Act, and is therefore unenforceable.
This
indemnity agreement shall be in addition to any liabilities that the Partnership
may otherwise have in connection with this offering.
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(b)
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The
Dealer agrees to indemnify and hold harmless the Partnership against
any
losses, claims, damages or liabilities, joint or several, to which
it may
become subject under applicable law, insofar as such losses, claims,
damages or liabilities (or actions in respect thereof) arise out
of or are
based upon a breach of the terms of this Agreement or the failure
to
comply with laws and regulations applicable to the offering and the
claim
of registration or exemption made by the Partnership, and will reimburse
the Partnership for any legal or other expenses reasonably incurred
in
connection with investigating or defending any such loss, claim,
damage or
liability (or action in respect thereof). This indemnity
agreement shall be in addition to any liability that the Dealer may
otherwise have in connection with the
offering.
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The
foregoing agreement shall extend upon the same terms and conditions
to,
and shall inure to the benefit of, each person, if any who controls
the
Partnership.
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(c)
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Within
ten days after receipt of an indemnified party of notice of the
commencement of any action, such indemnified party shall, if a claim
in
respect thereof is to be made against the indemnifying party under
subsections (a) or (b) of this Article XIII, notify the indemnifying
party
in writing of the commencement thereof; the omission by any indemnified
party to notify the indemnifying party of any such action shall relieve
the indemnifying party from any liability in respect of such action
that
it may have to such indemnified party on account of this indemnity
agreement; but the omission so to notify the indemnifying party shall
not
relieve it from any liability that it may have to any indemnified
party
otherwise than under such subsection. In case any such action
shall be brought against such indemnified party, and it shall notify
the
indemnifying party of the commencement thereof, the indemnifying
party
shall be entitled to participate in, and, to the extent that it shall
wish, jointly with any other indemnifying party similarly notified,
to
assume the defense thereof, with counsel satisfactory to such indemnifying
and indemnified parties, and after the indemnified party shall have
received notice from the agreed-upon counsel that the defense has
been so
assumed, in the event that the indemnified party nonetheless elects
to
participate in the defense of any such action for any reason other
than
the presence of a conflict of interest, the indemnifying party shall
not
be responsible for any legal or other expenses subsequently incurred
by
such indemnified party in connection with the defense
thereof.
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XIV. Termination
The
Dealer will suspend or terminate its offer and sale of Units upon the request
of
the Partnership at any time and will resume its offer and sale of Units
hereunder upon subsequent request of the Partnership. Any party may
terminate this Agreement by written notice. Such termination shall be
effective five days after the mailing of such notice. No such
termination shall operate to terminate any rights the Dealer may have to be
paid
a commission with respect to subscriptions that were obtained by the Dealer
and
submitted to the Partnership for acceptance prior to that
termination. This Agreement is the entire agreement of the parties
and supersedes all prior agreements, if any, between the parties
hereto.
This
Agreement may be amended at any time by the Partnership by written notice to
the
Dealer, and any such amendment shall be deemed accepted by the Dealer upon
placing an order for sale of Units after receipt of such notice.
XV.
Privacy Laws
The
Partnership and the Dealer (each referred to individually in this section as
a
“party”) agree as follows:
(a) Each
party agrees to abide by and comply with (i) the privacy standards and
requirements of the Xxxxx-Xxxxx-Xxxxxx Act of 1999 (“GLB Act”), (ii) the privacy
standards and requirements of any other applicable federal or state law, and
(iii) its own internal privacy policies and procedures, each as may be amended
from time to time.
(b) Each
party agrees to refrain from the use or disclosure of nonpublic personal
information (as defined under the GLB Act) of all customers who have opted
out
of such disclosures except as necessary to service the customers or as otherwise
necessary or required by applicable law; and
(c) Each
party shall be responsible for determining which customers have opted out of
the
disclosure of nonpublic personal information by periodically reviewing and,
if
necessary, retrieving a list of such customers (the “List”) as provided by each
to identify customers that have exercised their opt-out rights. In the event
either party uses or discloses nonpublic personal information of any customer
for purposes other than servicing the customer, or as otherwise required by
applicable law, that party will consult the List to determine whether the
affected customer has exercised his or her opt-out rights. Each party
understands that each is prohibited from using or disclosing any nonpublic
personal information of any customer that is identified on the List as having
opted out of such disclosures.
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XVI. Notice
All
notices will be in writing and will be duly given to the Dealer when mailed
to
the address specified by the Dealer herein.
XVII.
Survival of Provisions
The
respective agreements, representations and warranties of the Partnership and
the
Dealer set forth in this Agreement shall remain operative and in full force
and
effect regardless of (a) any termination of this Agreement, (b) any
investigation made by or on behalf of the Dealer or any person controlling
the
Dealer or by or on behalf of the Partnership or any person controlling the
Partnership, and (c) the acceptance of any payment for the Units.
XVIII.
Attorneys’
Fees,
Applicable
Law and Venue
In
any
action to enforce the provisions of this Agreement or to secure damages for
its
breach, the prevailing party shall recover its costs and reasonable attorney’s
fees. This Agreement shall be construed under the laws of the State
of Texas and shall take effect when signed by the Dealer and countersigned
by
the Partnership. Venue for any action (including arbitration) brought
hereunder shall lie exclusively in Dallas, Texas.
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IN
WITNESS WHEREOF, each of the parties hereto has caused this Agreement to be
executed on its behalf by its duly authorized agent.
UNITED DEVELOPMENT FUNDING III, L.P. | |||
By: | UMTH Land Development, L.P. | ||
Its General Partner |
By: | UMT Services, Inc. | |||
Its General Partner | ||||
By: | ||||
Name: | ||||
Title: | ||||
Date: |
[Signature
of the Dealer on following page.]
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The
undersigned Dealer has read the foregoing Agreement and hereby accepts and
agrees to the terms and conditions therein set forth. The Dealer
represents that the list below of jurisdictions in which it is registered or
licensed as a broker or dealer and is fully authorized to sell securities is
true and correct, and the Dealer agrees to advise the Partnership of any change
in such list during the term of this Agreement.
1. Identity of Dealer:
Name: | |||
Type of entity: | |||
(corporation, partnerhip, proprietorship, etc.)
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Organized in the State of: | |||
Licensed as broker-dealer in the following States: | |||
Tax I.D. #: | |||
2. Person
to receive notice pursuant to Section XVI:
Name: | |||
Company: | |||
Address: | |||
City, State and Zip Code: | |||
Telephone No.: | ( ) | ||
Facsimile No.: | ( ) | ||
AGREED TO AND ACCEPTED BY THE DEALER: | |||
(Dealer's
Firm
Name)
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By: | ||||
(Signature)
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Name: | ||||
Title: | ||||
Date: |
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