Info Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=120 BGCOLOR="#006699" TEXT="#080000"> <div> <B>                                                     </B></div> <DIV ALIGN="LEFT"></DIV> <div> <B> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="946" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="LEFT" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER ROWSPAN=2 COLSPAN=5 HEIGHT= 21 ><NOBR><div> <B><IMG SRC="07b8a280.jpg" border=0 width="650" height="40" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </NOBR></tD> </tR> <tR> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 21 WIDTH="156"><div> <A HREF="index.htm" TARGET="_top" TITLE="Leslie Depweg Chico Realtor"><B>Home Page</B></A></div> </tD> <tD VALIGN=CENTER WIDTH="246"><div> <A HREF="chico_multiple_listings.htm" TARGET="_top" TITLE="Chico Multiple Listings"><B>Chico Multiple Listings</B></A></div> </tD> <tD VALIGN=CENTER><NOBR><div> <A HREF="id32.htm" TARGET="_top" TITLE="Leslie Information"><B>A Bit About Leslie</B></A></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="171"><div> <A HREF="id16.htm" TARGET="_top" TITLE="Leslies Mission"><B>My Mission</B></A></div> </tD> <tD VALIGN=CENTER ROWSPAN=2 WIDTH="171"><div> <A HREF="id61.htm" TARGET="_top" TITLE="Awards Commendations"><B>Awards and Commendations</B></A></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 21 ><NOBR><div> <A HREF="id45.htm" TARGET="_top" TITLE="Featured Listings"><B>Featured Listings</B></A></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <A HREF="id17.htm" TARGET="_top" TITLE="Chico Area Information"><B>Chico Area Information</B></A></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <A HREF="id3.htm" TARGET="_top" TITLE="Services"><B>Services I Provide</B></A></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="171"><div> <B>Contact Leslie</B></div> </tD> </tR> </TABLE></B></div> <div> <B>      </B></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#C0C0C0" TEXT="#080000" bgproperties="fixed" background="043d2042excwnc.jpg"> <div> <B><IMG SRC="050b4fc0.jpg" border=0 width="180" height="252" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>Leslie Depweg</B></div> <div> <B>Graduate Realtor Institute</B></div> <div> <B> Accredited Buyer Representation</B></div> <div> <B>Phone: (530) 828-3846</B></div> <div> <B><IMG SRC="055a55a0.jpg" border=0 width="165" height="90" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>CHICO</B></div> <div> <B>REAL ESTATE</B></div> <div> <B>"Expect the Best!"</B></div> <div> <B><IMG SRC="218a0640.png" border=0 width="160" height="100" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </td> <td valign="top" height=360 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Please fill in the following form and</B></div> <div> <B>I will respond very promptly.</B></div> <div>  <HTML> <FORM METHOD=POST ACTION="http://www.lesliedepweg.com/cgi-bin/formmail/FormMail.pl" > <INPUT type=hidden name="recipient" value="leslie.depweg@coldwellbanker.com"> <INPUT type=hidden name="subject" value="You Have Received an Information Request"> <BGCOLOR="#FFFFFF"> <TABLE cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td><input type="checkbox" name="Buyer" value="Yes, I'm planning to buy."> I'm planning to buy a home.</td> </tr> <tr><td><input type="checkbox" name="Seller" value="Yes, I'm planning to sell."> I'm planning to sell a home.</td></tr> </tr> <tr><td><font color="#FFFFFF">xxxxxxxxxx</font color></td></tr> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="EmailAddr" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Street Address:<br> <input type="text" name="StreetAddress" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Apartment #:<br> <input type="text" name="AptNum" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip Code:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Fax Number:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr><td><br><input type="checkbox" name="MailingList" value="Yes, please add my name."> Please add me to your mailing list<br></td></tr> </TABLE> <BR><FONT SIZE="3"> <P ALIGN="CENTER">Information I'd Like to Receive:</FONT><BR> <textarea name="Information Requests" rows="7" cols="40"></textarea> <BR><BR></P> <input type="reset" value="Clear Entries"> <input type="submit" value="Send Request"></td> </FORM> </HTML>  </div> <bR> <div> <A HREF="id6.htm" TARGET="_top" TITLE="Contact Leslie"><B>Return to "Contact Leslie"</B></A></div> <bR> </td> </tr></table></body>