Continuum II

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align="right">MLS Number</div></td><td width="25%" class="celltext"><input name="propertyId" type="text" class="srhBox" value="" size="20" readonly></td><td width="25%" class="celltextcolor"><div align="right">*Name:</div></td><td width="25%" class="celltext"><input name="name" type="text" class="srhBox" size="20" tabindex="1"></td></tr><tr><td width="25%" class="celltextcolor"><div align="right">Price:</div></td><td width="25%" class="celltext"><input name="price" type="text" class="srhBox" value="" size="20" readonly></td><td width="25%" class="celltextcolor"><div align="right">Address:</div></td><td width="25%" class="celltext"><input name="address" type="text" class="srhBox" size="20" value="" tabindex="2"></td></tr><tr><td class="celltextcolor"><div align="right">Address:</div></td><td class="celltext"><input readonly type="text" class="srhBox" name="PropertyAddress" size="20" value="50 SOUTH POINTE DRIVE"></td><td class="celltextcolor"><div align="right">City:</div></td><td class="celltext"><input name="city" type="text" class="srhBox" size="20" tabindex="3"></td></tr><tr><td class="celltextcolor">&nbsp;</td><td class="celltext">&nbsp;</td><td class="celltextcolor"><div align="right">State:</div></td><td class="celltext"><input name="state" type="text" class="srhBox" size="2" maxlength="2" tabindex="4"></td></tr><tr><td class="celltextcolor">&nbsp;</td><td class="celltext">&nbsp;</td><td class="celltextcolor"><div align="right">Zip Code:</div></td><td class="celltext"><input name="zip" type="text" class="srhBox" size="20" tabindex="5"></td></tr><tr><td class="celltextcolor">&nbsp;</td><td class="celltext">&nbsp;</td><td class="celltextcolor"><div align="right">*Email:</div></td><td class="celltext"><input name="email" type="text" class="srhBox" size="20" tabindex="6"></td></tr><tr><td class="celltextcolor">&nbsp;</td><td class="celltext">&nbsp;</td><td class="celltextcolor"><div align="right">*Phone:</div></td><td class="celltext"><input name="phone" type="text" class="srhBox" size="20" tabindex="7"></td></tr></table><table width="715" cellpadding="1" cellspacing="2" height="10" class="RequestInfoMore"><tr><td colspan="4" class="celltext"><table width="100%" border="0" cellspacing="0" cellpadding="3"><tr><td width="63%" class="text">Please provide me with more information about your services</td><td width="37%" class="text"><input type="checkbox" value="ON" name="C1" tabindex="8"></td></tr></table></td></tr><tr><td colspan="4" class="celltext"><table width="100%" border="0" cellspacing="0" cellpadding="3"><tr><td width="63%" class="text">Please provide information about surrounding areas</td><td width="37%"><input type="checkbox" value="ON" name="C2" tabindex="9"></td></tr></table></td></tr><tr><td colspan="4" class="celltext"><table width="100%" border="0" cellspacing="0" cellpadding="3"><tr><td width="63%" class="text">I am planning to buy or sell real estate property in</td><td width="37%"><select name="timeFrame" size="1" class="srhBox" tabindex="10"><option value="0">Immediately</option><option value="1 Month">1 Month</option><option value="2 Months">2 Months</option><option value="3 Months">3 Months</option><option value="6 Monhts">6 Months</option><option value="8 Months">8 Months</option><option value="12 Months">12 Months</option><option value="Over 12 Months">Over 12 Months</option></select></td></tr><tr><td width="63%" class="text">How did you find our website</td><td width="37%"><select name="howdidyoufindus" size="1" class="srhBox" tabindex="10"><option value=""></option><option value="Google">Google</option><option value="MSN">MSN</option><option value="Yahoo">Yahoo</option><option value="Other Search Engines">Other Search Engines</option><option value="Direct Mailing">Direct Mailing</option><option value="Email Advertising">Email Advertising</option><option value="Newspaper">Newspaper</option><option value="Other">Other</option></select></td></tr></table></td></tr></table><table width="715" cellpadding="1" cellspacing="2" height="10"><tr><td colspan="4" class="celltext">&nbsp;</td></tr><tr><td colspan="4" class="celltextBOLD">Special Instructions:</td></tr><tr><td colspan="4" class="celltextBOLD"><textarea name="instructions" cols="75" rows="7" class="srhBox" tabindex="11"></textarea></td></tr><tr><td colspan="4" class="celltext">All personal information will be kept confidential</td></tr><tr><td colspan="4" class="celltext">* By submitting this form with your telephone number you are consenting for Jill Hertzberg &#38; Jill Eber and all authorized representatives to contact you even if your name is on the <a href="https://www.donotcall.gov/default.aspx" target="_new">Federal Do-Not-Call List</a></td></tr><tr class="celltextcolor"><td colspan="4" class="celltext"><table width="15%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td width="21%"><input tabindex="12" onclick="self.status='';return true;" onmouseover="self.status='Click to begin search';return true;" onmouseout="self.status='';return true;" type="image" src="images/submit_button.gif" name="Submit"></td><td width="79%"><a tabindex="13" onclick="self.status='';return true;" onmouseover="self.status='Click to reset form';return true;" onmouseout="self.status='';return true;" href="javascript:form1.reset()"><img src="images/reset.gif" border="0"></a></td></tr></table></td></tr><tr><td colspan="4" class="celltext" height="100%" valign="top"><table width="100%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td colspan="4" class="text" align="right" height="100%" valign="top">&nbsp; <a onclick="self.status='';return true;" onmouseover="self.status='Return to the previous page';return true;" onmouseout="self.status='';return true;" href="javascript:window.history.back();">< < Back</a>&nbsp;</td></tr></table></td></tr><tr><td height="100%" colspan="4" valign="top" class="celltext" align="center"><a href="http://www.resionline.com" target="_blank"><img 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Updated: Wednesday, July 30, 2014

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