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   document.write("<center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1485933833\"><input type=\"hidden\" name=\"meta_split_id\" value=\"1268211865\"><input type=\"hidden\" name=\"unit\" value=\"theearl-sellers\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.theearlofrealestate.net/thankyou.aspx\" id=\"redirect_ffff1998ab4af2b4f638e337e7144911\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from,custom Phone number - Work or Cell\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div style=\"font-family: Verdana\"><font style=\"font-weight: bold\" size=\"1\">The Earl of Real Estate Team will call you by phone so that he can set up an appointment  to take a look at the property and review the results with you based upon the  specifics of your property!</font></div></center></td></tr><tr><td colspan=\"2\" align=\"left\">- - - - -  Address of your property::</td></tr><tr><td>Street address:</td><td><input type=\"text\" name=\"custom Street address\" value=\"\" size=\"20\"></td></tr><tr><td>City:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr><tr><td>State:</td><td><input type=\"text\" name=\"custom State\" value=\"Virginia\" size=\"20\"></td></tr><tr><td>Zip:</td><td><input type=\"text\" name=\"custom Zip\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">- - - - -  Details of your property::</td></tr><tr><td>Type of home:</td><td><input type=\"text\" name=\"custom Type of home\" value=\"\" size=\"20\"></td></tr><tr><td>Primary Residence or Investment-Rental:</td><td><input type=\"text\" name=\"custom Primary Residence or Investment-Rental\" value=\"\" size=\"20\"></td></tr><tr><td>Number of bedrooms:</td><td><input type=\"text\" name=\"custom Number of bedrooms\" value=\"\" size=\"20\"></td></tr><tr><td>Number of full baths:</td><td><input type=\"text\" name=\"custom Number of full baths\" value=\"\" size=\"20\"></td></tr><tr><td>Number of half baths:</td><td><input type=\"text\" name=\"custom Number of half baths\" value=\"\" size=\"20\"></td></tr><tr><td>Square feet:</td><td><input type=\"text\" name=\"custom Square feet\" value=\"\" size=\"20\"></td></tr><tr><td>Year built:</td><td><input type=\"text\" name=\"custom Year built\" value=\"\" size=\"20\"></td></tr><tr><td valign=\"top\">Special features or recent remodeling details:</td><td><textarea name=\"custom Special features or recent remodeling details\" rows=\"7\" cols=\"20\"></textarea></td></tr><tr><td colspan=\"2\" align=\"left\">When are you planning on selling your property?:</td></tr><tr><td colspan=\"2\" align=\"left\">Within the next:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Within the next\" value=\"1 Month\"> 1 Month</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Within the next\" value=\"2 Months\"> 2 Months</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Within the next\" value=\"3 Months\"> 3 Months</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Within the next\" value=\"6 Months\"> 6 Months</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Within the next\" value=\"12 Months\"> 12 Months</td></tr><tr><td colspan=\"2\" align=\"left\">- - - - - Please tell us how to contact you::</td></tr><tr><td>First & Last Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Phone number - Work or Cell:</td><td><input type=\"text\" name=\"custom Phone number - Work or Cell\" value=\"\" size=\"20\"></td></tr><tr><td>Phone number - Home:</td><td><input type=\"text\" name=\"custom Phone number - Home\" value=\"\" size=\"20\"></td></tr><tr><td>Best Time to See Your Property:</td><td><input type=\"text\" name=\"custom Best Time to See Your Property\" value=\"\" size=\"20\"></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

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