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document.write(" | Last Name: | \n");
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document.write(" | Address 1: | \n");
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document.write(" | Address 2: | \n");
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document.write(" | Email Address: | \n");
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document.write(" | Home Phone: | \n");
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document.write(" | Best Time: | \n");
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document.write(" | Work Phone: | \n");
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document.write(" | Best Time: | \n");
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document.write("Is your home currently on the market?: | \n");
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document.write("Yes
No
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document.write("When do you plan to move?: | \n");
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document.write("now
Less than 3 months
3 to 6 months
Other
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document.write(" |
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document.write(" | Where would you like to relocate?: | \n");
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document.write("Number of Bedrooms: | \n");
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document.write("Less than 2
3 to 4
More than 4
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document.write("Type of Home: | \n");
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document.write("Traditional
Contemporary
Ranch
Split Level
Two Story
Split Foyer
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document.write("Exterior: | \n");
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document.write("Brick
Vinyl
Stucco
Other
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document.write(" | If Other Please Explain: | \n");
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document.write("Age of Property: | \n");
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document.write("Less than 5 years
5 to 10 years
More than 10 years
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document.write("Number of Baths: | \n");
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document.write("1
2
3 or more
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document.write("Basement: | \n");
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document.write("Full
Partial
Slab/Crawl
Finished
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document.write("Approximate Price Range: | \n");
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document.write("Less than $100,000
$100,000 to $150,000
$150,000 to $200,000
$200,000 to $250,000
Greater than $250,000
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document.write(" | Additional Comments: | \n");
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