document.write("<form  method=POST action=\"http://www.josiesque.com/cgi-bin/csFormbuilder/csFormbuilder.cgi\" name=\"form_406\"  >\n");
document.write("<input type=hidden name=form-id value=\"406\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.josiesque.com/cgi-scr"+"ipt/csFormbuilder/forms/SladekRealEstateContactForm.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td class=\"textLabel\" colspan=2>Please fill out the following information and click the submit button. \"*\" indicates mandatory fields.</td></tr><tr><td class=\"textLabel\" colspan=2><hr width=\"100%\" size=\"1\" color=\"black\" align=\"left\"></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*First Name</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Name\"  size=\"35\"   maxlength=\"50\" ></td>\n");
document.write("</tr>\n");
document.write("</table>  <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Last Name</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"LastName\"  size=\"35\"   maxlength=\"50\" ></td>\n");
document.write("</tr>\n");
document.write("</table><!-- tr ph 1--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">Email</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Email\"  size=\"35\"   maxlength=\"100\" ></td>\n");
document.write("</tr>\n");
document.write("</table>  <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">Phone Number</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"PhoneNumber\"  size=\"20\"   maxlength=\"20\" ></td>\n");
document.write("</tr>\n");
document.write("</table><!-- tr ph 3--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2  height=\"10\" ></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Type of listing you are interested in </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><table border=0 cellspacing=2 cellpadding=0><tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"ListingType\" value=\"Single family home\"></td><td class=\"textLabel\">Single family home</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"ListingType\" value=\"Townhouse\"></td><td class=\"textLabel\">Townhouse</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"ListingType\" value=\"Condo\"></td><td class=\"textLabel\">Condo</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"ListingType\" value=\"Commercial\"></td><td class=\"textLabel\">Commercial</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"ListingType\" value=\"Acreage\"></td><td class=\"textLabel\">Acreage</td>\n");
document.write("</tr></table>\n");
document.write("</td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 4--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2  height=\"10\" ></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">City and/or County you are interested in</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"CityCounty\"  size=\"40\"   maxlength=\"60\" ></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 5--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2  height=\"10\" ></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Price Range </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"PriceRange\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>Under $50,000</option>\n");
document.write("<option>$55,000 - $100,000</option>\n");
document.write("<option>$105,000 - $150,000</option>\n");
document.write("<option>$155,000 - $200,000</option>\n");
document.write("<option>$205,000 - $250,000</option>\n");
document.write("<option>$255,000 - $300,000</option>\n");
document.write("<option>$305,000 - $350,000</option>\n");
document.write("<option>$355,000 - $400,000</option>\n");
document.write("<option>$405,000 - $450,000</option>\n");
document.write("<option>$455,000 - $500,000</option>\n");
document.write("<option>$505,000 - $550,000</option>\n");
document.write("<option>$555,000 - $600,000</option>\n");
document.write("<option>$605,000 - $650,000</option>\n");
document.write("<option>$655,000 - $700,000</option>\n");
document.write("<option>$705,000 - $750,000</option>\n");
document.write("<option>$755,000 - $800,000</option>\n");
document.write("<option>$805,000 - $850,000</option>\n");
document.write("<option>$855,000 - $900,000</option>\n");
document.write("<option>$905,000 - $950,000</option>\n");
document.write("<option>$955,000 - $1,000,000</option>\n");
document.write("<option>No Maximum</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table>  <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">Square Footage </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"SquareFootage\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>Less than 1,000</option>\n");
document.write("<option>1,100 - 1,500</option>\n");
document.write("<option>1,600 - 2,000</option>\n");
document.write("<option>2,100 - 2,500</option>\n");
document.write("<option>2,600 - 3,000</option>\n");
document.write("<option>3,100 - 3,500</option>\n");
document.write("<option>3,600 - 4,000</option>\n");
document.write("<option>4,100 - 4,500</option>\n");
document.write("<option>4,600 - 5,000</option>\n");
document.write("<option>Over 5,000</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table> <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\"># of Bedrooms </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"Bedrooms\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>1</option>\n");
document.write("<option>2</option>\n");
document.write("<option>3</option>\n");
document.write("<option>4</option>\n");
document.write("<option>5</option>\n");
document.write("<option>5+</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table> <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\"># of Baths </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"Baths\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>1</option>\n");
document.write("<option>1 1/2</option>\n");
document.write("<option>2 </option>\n");
document.write("<option>2 1/2</option>\n");
document.write("<option>3</option>\n");
document.write("<option>3 1/2</option>\n");
document.write("<option>4</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table><!-- tr ph 9--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2  height=\"15\" ></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">Comments/Questions</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"Comments\"  rows=\"4\" cols=\"40\"   maxlength=\"1000\" ></textarea></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 10--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"left\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\":: Submit ::\"></td></tr>\n");
document.write("</table>\n");
document.write("</form>\n");