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Name:	*
Address:
City:	*
State:
Zip/Postal Code:
Phone Number
Fax Number:
E-Mail:	*
Is your Home Currently Listed?		Yes No
Type of Home		Single Family Condo Duplex Townhome
Description of home or property	*
Sales Price range of property:		Choose One Under $50,000 $50 - $100,00 $100 - $150,000 $150 - $200,000 $200 - $250,000 $250,000 Plus 500,000 to 750,000 750,000 to 1 mil 1 million and up
How soon are you planning to sell?
Best way to contact you?		E-mail Phone
What is the best time to contact you:
Please contact me ASAP!		Yes
Security Code	*