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<table width="600" cellpadding="1" cellspacing="2" height="100%">
<tr>
<td colspan="4" class="celltext"><table width="100%" style="height:100%;" border="0" align="right" cellpadding="3" cellspacing="0"> <tr> <td width="50%" valign="top" align="center" class="textHF"><span class="textBOLD">Joan Andre</span><br>Jeanne Baker Realty<br>phone: (305) 4469222<br> <a href="mailto:joaneandre@aol.com">joaneandre@aol.com</a> </td> </tr></table></td>
</tr>
<tr>
<td colspan="4" class="celltext" align="right" height="25" valign="middle">
<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>
</td>
</tr>
<tr>
<td colspan="2" class="celltextBOLD">Personal
Information:</td>
<td colspan="2" class="celltextBOLD">Optional
Information: </td>
</tr>
<tr>
<td width="20%" class="celltextcolor" align="right">*First Name:</td>
<td width="25%" class="celltext">
</td>
<td width="20%" class="celltextcolor" align="right">Address:</td>
<td width="25%" class="celltext">
</td>
</tr>
<tr>
<td width="20%" class="celltextcolor" align="right">*Last Name:</td>
<td width="25%" class="celltext">
</td>
<td width="20%" class="celltextcolor" align="right">City:</td>
<td width="25%" class="celltext">
</td>
</tr>
<tr>
<td width="20%" class="celltextcolor" align="right">*Email Address:</td>
<td class="celltext" class="text">
</td>
<td width="20%" class="celltextcolor" align="right">State/Province:</td>
<td class="celltext">
Select One
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Iowa
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Viriginia
Washington
Washington DC
West Virignia
Wisconsin
Wyoming
</td>
</tr>
<tr>
<td width="20%" class="celltextcolor" align="right">*Phone Number:</td>
<td class="celltext">
</td>
<td width="20%" class="celltextcolor" align="right">ZIP/Postal Code:</td>
<td class="celltext">
</td>
</tr>
<tr>
<td colspan="1" class="celltextcolor" valign="top" align="right">Comments:</td>
<td width="" valign="top" class="celltext" colspan="3">
</td>
</tr>
<tr>
<td height="" colspan="4" class="celltext"> </td>
</tr>
<tr>
<td colspan="4" class="celltextBOLD">Property Information:</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">Why are you moving?</td>
<td colspan="2" class="celltext"></td>
</tr>
<tr>
<td colspan="2" nowrap class="celltextcolor">Do you own your current home or are you renting?</td>
<td colspan="2" class="celltext">
Rent
Own
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">How many people will be living in this home?</td>
<td colspan="2" class="celltext">
1
2
3
4
5+
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">When would you like to be in your new home?</td>
<td colspan="2" class="celltext"></td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">How many bedrooms do you need?</td>
<td colspan="2" class="celltext">
1
2
3
4
5+
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">How many bathrooms?</td>
<td colspan="2" class="celltext">
1
2
3
4
5+
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">Do you need a garage?</td>
<td colspan="2" class="celltext">
No
Cover
1 Car
2 Car
3 or more
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">What is your desired price range?</td>
<td colspan="2" class="celltext">
Select One
$ 100,000
$ 150,000
$ 200,000
$ 250,000
$ 300,000
$ 350,000
$ 400,000
$ 450,000
$ 500,000
$ 550,000
$ 600,000
$ 650,000
$ 700,000
$ 750,000
$ 800,000
$ 850,000
$ 900,000
$ 950,000
$ 1,000,000
$ 1,250,000
$ 1,500,000
$ 1,750,000
$ 2,000,000
$ 2,250,000
$ 2,500,000
$ 2,750,000
$ 3,000,000
$ 3,250,000
$ 3,500,000
$ 3,750,000
$ 4,000,000
$ 4,250,000
$ 4,500,000
$ 4,750,000
$ 5,000,000
$ 6,000,000
$ 7,000,000
$ 8,000,000
$ 9,000,000
$ 10,000,000
To
Select One
$ 100,000
$ 150,000
$ 200,000
$ 250,000
$ 300,000
$ 350,000
$ 400,000
$ 450,000
$ 500,000
$ 550,000
$ 600,000
$ 650,000
$ 700,000
$ 750,000
$ 800,000
$ 850,000
$ 900,000
$ 950,000
$ 1,000,000
$ 1,250,000
$ 1,500,000
$ 1,750,000
$ 2,000,000
$ 2,250,000
$ 2,500,000
$ 2,750,000
$ 3,000,000
$ 3,250,000
$ 3,500,000
$ 3,750,000
$ 4,000,000
$ 4,250,000
$ 4,500,000
$ 4,750,000
$ 5,000,000
$ 6,000,000
$ 7,000,000
$ 8,000,000
$ 9,000,000
$ 10,000,000
</td>
</tr>
<tr>
<td colspan="2" nowrap class="celltextcolor">List any special features that are important to you</td>
<td colspan="2" class="celltext"></td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">Have you been pre-approved for a home loan?</td>
<td colspan="2" class="celltext">
Yes
No
</td>
</tr>
<tr>
<td colspan="2" class="celltextcolor">When is the best time for you to view homes?</td>
<td colspan="2" class="celltext">
Day
Evenings
</td>
</tr>
<tr>
<td colspan="4" class="celltext">
* By submitting this form with your telephone number you are consenting for Joan Andre any 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>
<br><br><a href="#" onClick="window.open('custPrivacyPolicy.asp?id=0346087','Terms','scrollbars=yes,width=450,height=250')">Privacy Policy</a>
</td>
</tr>
<tr>
<td colspan="4" class="celltextcolor">
<table width="15%" border="0" align="center" cellpadding="3" cellspacing="0">
<tr>
<td width="21%"></td>
<td width="79%"><a 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" valign="top" class="celltext">
<table width="100%" height="100%" border="0" cellpadding="3" cellspacing="0"> <tr> <td valign="top" align="center" class="textHF"><span class="textBOLD">Joan Andre</span><br>Jeanne Baker Realty<br>3162 Commodore Plaza #3E Miami, FL 33133<br>phone: (305) 4469222 <br>fax: (305) 448-9333 mobile: (305) 9040007<br> <a href="mailto:joaneandre@aol.com">joaneandre@aol.com</a> </td> </tr></table>
</td>
</tr>
<tr>
<td colspan="4" class="celltext" align="center">
<a href="http://www.resionline.com" target="_blank"><img src="images/resilogo.png" width="96" height="39" border="0"></a></td>
</tr>
</table>
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