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size=\"20\"></td></tr><tr><td>Email*:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Promo Code*:</td><td><input type=\"text\" name=\"custom Promo Code\" value=\"88888\" size=\"20\"></td></tr><tr><td>Address:</td><td><input type=\"text\" name=\"custom Address\" value=\"\" size=\"20\"></td></tr><tr><td>City State Zip:</td><td><input type=\"text\" name=\"custom City State Zip\" value=\"\" size=\"20\"></td></tr><tr><td>Phone Numbers:</td><td><input type=\"text\" name=\"custom Phone Numbers\" value=\"\" size=\"20\"></td></tr><tr><td>When are you looking to purchase:</td><td><input type=\"text\" name=\"custom When are you looking to purchase\" value=\"\" size=\"20\"></td></tr><tr><td>Are you PreApproved:</td><td><input type=\"text\" name=\"custom Are you PreApproved\" value=\"\" size=\"20\"></td></tr><tr><td>Cities of Interest Put most interested first:</td><td><input type=\"text\" name=\"custom Cities of Interest Put most interested first\" value=\"\" size=\"20\"></td></tr><tr><td>State of Interest:</td><td><input type=\"text\" name=\"custom State of Interest\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">Are you interested in:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Are you interested in\" value=\"Lease Option or Land Contract\"> Lease Option or Land Contract</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Are you interested in\" value=\"Buying an investment property to rent out\"> Buying an investment property to rent out</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Are you interested in\" value=\"Buying an investment property to rehab\"> Buying an investment property to rehab</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Are you interested in\" value=\"Buying for Yourself\"> Buying for Yourself</td></tr><tr><td>Minimum Number of Bedrooms:</td><td><input type=\"text\" name=\"custom Minimum Number of Bedrooms\" value=\"\" size=\"20\"></td></tr><tr><td>Minimum Number of Bathrooms:</td><td><input type=\"text\" name=\"custom Minimum Number of Bathrooms\" value=\"\" size=\"20\"></td></tr><tr><td>Price Range Low to High:</td><td><input type=\"text\" name=\"custom Price Range Low to High\" value=\"\" size=\"20\"></td></tr><tr><td>Monthly Payment Range Low to High:</td><td><input type=\"text\" name=\"custom Monthly Payment Range Low to High\" value=\"\" size=\"20\"></td></tr><tr><td>Down Payment Range Low to High:</td><td><input type=\"text\" name=\"custom Down Payment Range Low to High\" value=\"\" size=\"20\"></td></tr><tr><td>Current Housing Status:</td><td><select name=\"custom Current Housing Status\"><option value=\"Own\" selected>Own</option><option value=\"Rent\">Rent</option><option value=\"Other\">Other</option></select></td></tr><tr><td>Current Monthly Rent or Mortgage Amount:</td><td><input type=\"text\" name=\"custom Current Monthly Rent or Mortgage\" value=\"\" size=\"20\"></td></tr><tr><td>Date of Residence:</td><td><input type=\"text\" name=\"custom Date of Residence\" value=\"\" size=\"20\"></td></tr><tr><td>Job Title:</td><td><input type=\"text\" name=\"custom Job Title\" value=\"\" size=\"20\"></td></tr><tr><td>Employer Name:</td><td><input type=\"text\" name=\"custom Employer Name\" value=\"\" size=\"20\"></td></tr><tr><td>Date of Employment:</td><td><input type=\"text\" name=\"custom Date of Employment\" value=\"\" size=\"20\"></td></tr><tr><td>Marrital Status:</td><td><input type=\"text\" name=\"custom Marrital Status\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">Checking Account:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Checking Account\" value=\"Yes\" checked> Yes</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Checking Account\" value=\"No\"> No</td></tr><tr><td colspan=\"2\" align=\"left\">Savings Account:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Savings Account\" value=\"Yes\" checked> Yes</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Savings Account\" value=\"No\"> No</td></tr><tr><td>Date of Birth:</td><td><input type=\"text\" name=\"custom Date of Birth\" value=\"\" size=\"20\"></td></tr><tr><td>Social Security Number:</td><td><input type=\"text\" name=\"custom Social Security Number\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><div>A current credit report may or may not be obtained. We will use this information to qualify you for a loan through a traditional lender                                    or through our owner financing program.</div></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

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