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<td width="145" height="100%" rowspan="2" valign="top" background="images/nav/sub_nav_bg.gif">
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<td width="610" height="100%" rowspan="2" valign="top"><table width="610" border="0" cellspacing="0" cellpadding="0">
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<td width="759" height="73" valign="bottom" style=padding:12px><img src="images/home_value_assesment_title.gif" alt="Home Value Assesment" width="586" height="26"></td>
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<td style="padding: 10px;" class="mainText">Please fill-out the following Home Value Analysis
Form. Based on the input we receive from this form, an analysis of
most recently sold properties that match your home will be prepared
for you in a timely fashion. </td>
</tr>
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<td><table width="600" border="0" cellspacing="0" cellpadding="4">
<tr>
<td colspan="2"><hr size="1" noshade color="B7A000"></td>
</tr>
<tr>
<td class="mainText"><strong>Personal Info:</strong></td>
<td width="375"> </td>
</tr>
<tr>
<td class="mainText">First Name<br></td>
<td></td>
</tr>
<tr>
<td class="mainText">Last Name</td>
<td></td>
</tr>
<tr>
<td class="mainText">Your Address</td>
<td></td>
</tr>
<tr>
<td class="mainText">City</td>
<td></td>
</tr>
<tr>
<td class="mainText">State/Province</td>
<td>-- Select --Outside U.S.Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
</td>
</tr>
<tr>
<td class="mainText">Zip/Postal</td>
<td></td>
</tr>
<tr>
<td class="mainText">Country</td>
<td>-- Select --Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbajan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia & Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burrkina Faso
Burundi
Camaras
Cambodia
Cameroon
Canada
Canary Islands, The
Cape Verde
Caroline Island
Cayman Islands
Central African Republic
Chad
Chile
China, People's Republic
Colombia
Congo
Congo, The Democratic Republic
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic, The
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
Eire
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethopia
Falkland Islands
Faroe Island
Fiji
Finland
France
French Guiana
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea Republic
Guinea-Bissau
Guyana (British)
Haiti
Honduras, Republic
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland, Northern (UK)
Ireland, Republic Of
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, DPR (North Korea)
Korea, Republic Of
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxemburg
Macau
Macedonia, Republic Of
Macronesia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova, Republic Of
Monaco
Mongolia
Montserrat
Morroco
Mozambique
Myanmar
Namibia
Nauru, Republic Of
Nepal
Netherlands, The
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines, The
Poland
Portugal
Puerto Rico
Qatar
Reunion, Island Of
Romania
Russian Federation, The
Rwanda
Saipan
Sao Tome and Principe
Saudi Arabia
Scotland (UK)
Sengal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovania
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Barthelemy
St. Eustatius
St. Kitts
St. Lucia
St. Maarten
St. Vincent
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbawe
</td>
</tr>
<tr>
<td class="mainText">Phone - Day</td>
<td></td>
</tr>
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<td class="mainText">Phone - Evening</td>
<td></td>
</tr>
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<td class="mainText">Fax</td>
<td></td>
</tr>
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<td class="mainText">Email</td>
<td></td>
</tr>
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<td class="mainText">Re-Type Email</td>
<td></td>
</tr>
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<td colspan="2" class="mainText"><hr size="1" noshade color="B7A000"></td>
</tr>
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<td class="mainText"><strong>Property Information:</strong></td>
<td> </td>
</tr>
<tr>
<td class="mainText">Property Address<br></td>
<td></td>
</tr>
<tr>
<td class="mainText">Property City</td>
<td>
Las Vegas
Henderson
</td>
</tr>
<tr>
<td class="mainText">Property State</td>
<td class="mainText">NV</td>
</tr>
<tr>
<td class="mainText">Property Zip</td>
<td></td>
</tr>
<tr>
<td class="mainText">Property Type</td>
<td>
Select One
Single Family
Condo
TownHome
</td>
</tr>
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<td class="mainText">What Do You Think Your <br>
Property is Worth?</td>
<td></td>
</tr>
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<td colspan="2" class="mainText"><hr size="1" noshade color="B7A000"></td>
</tr>
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<td class="mainText"><strong>Specific Information:</strong></td>
<td> </td>
</tr>
<tr>
<td class="mainText"># of Bedrooms<br> </td>
<td>
Select One
One
Two
Three
Four
Five
Over Five
</td>
</tr>
<tr>
<td class="mainText"># of Baths</td>
<td>
Select One
One
One and One-Half
Two
Two and One-Half
Three
Three and One-Half
Four
Four and One-Half
Over Five
</td>
</tr>
<tr>
<td class="mainText"># of Square Feet</td>
<td></td>
</tr>
<tr>
<td class="mainText"># of Stories</td>
<td>
Select One
One
Two
Tri-Level
</td>
</tr>
<tr>
<td class="mainText">Garage Style</td>
<td>
Select One
Attached
Detached
</td>
</tr>
<tr>
<td class="mainText">Garage # of Cars</td>
<td>
Select One
One
Two
Three
Four
Five
Car Port
</td>
</tr>
<tr>
<td class="mainText">Currently Listed?</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Neighborhood Name</td>
<td></td>
</tr>
<tr>
<td class="mainText">How Soon to Sell?</td>
<td>
Select One
Immediately
One to Three Months
Three to Six Months
Six to Nine Months
Nine to Twelve Months
Over 1 Year
</td>
</tr>
<tr>
<td class="mainText">Has Den/Office?</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Year Built</td>
<td></td>
</tr>
<tr>
<td class="mainText">Pool/Spa?</td>
<td>
Select One
Pool
Spa
Pool and Spa
</td>
</tr>
<tr>
<td class="mainText">Gated Community?</td>
<td>
Select One
No
Gated
Guard Gated
</td>
</tr>
<tr>
<td class="mainText">MasterBR 1st Floor?</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Casita?</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText"># of Fireplaces</td>
<td>
Select One
None
One
Two
</td>
</tr>
<tr>
<td class="mainText">Lot Square Footage</td>
<td></td>
</tr>
<tr>
<td class="mainText">Heating Type</td>
<td></td>
</tr>
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<td class="mainText">Cooling Type</td>
<td></td>
</tr>
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<td class="mainText">HOA Monthly Fee</td>
<td></td>
</tr>
<tr>
<td class="mainText">Currently a Rental Property?</td>
<td>
Select One
Yes
No
</td>
</tr>
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<td class="mainText">Are You the Property Owner Requesting This Home Value Analysis?</td>
<td class="mainText">
(type YES or NO)</td>
</tr>
<tr>
<td class="mainText">Reason for CMA<br> </td>
<td>
Select One
ReFinance
Selling Home
Ready to Exercise Lease Option to Buy
Will Sell as For Sale by Owner
</td>
</tr>
<tr>
<td class="mainText">Additional Amenities</td>
<td></td>
</tr>
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<td colspan="2" class="mainText"><hr size="1" noshade color="B7A000"></td>
</tr>
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<td class="mainText"><strong>Community Amenities:</strong></td>
<td> </td>
</tr>
<tr>
<td class="mainText">Golf Course<br></td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Pool</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Tennis Courts</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Club House</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Fitness Center</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td class="mainText">Over 55 Restricted</td>
<td>
Select One
Yes
No
</td>
</tr>
<tr>
<td colspan="2" class="mainText"><hr size="1" noshade color="B7A000"></td>
</tr>
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<td class="mainText"><strong>Referrals:</strong></td>
<td> </td>
</tr>
<tr>
<td colspan="2" class="mainText">Any friends you would like to refer to me that
want to buy or sell a home in Las Vegas?</td>
</tr>
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<td class="mainText">Name:</td>
<td></td>
</tr>
<tr>
<td class="mainText">City:</td>
<td></td>
</tr>
<tr>
<td class="mainText">Phone:</td>
<td></td>
</tr>
<tr>
<td class="mainText">Email:</td>
<td></td>
</tr>
<tr>
<td class="mainText">Buyer or Seller:</td>
<td>
Select One
Buyer
Seller
</td>
</tr>
<tr>
<td colspan="2"><hr size="1" noshade color="B7A000"></td>
</tr>
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<td><strong class="mainText"><b>Additional Comments:</b></strong></td>
<td> </td>
</tr>
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<td colspan="2"></td>
</tr>
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<td> </td>
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<td width="33"><a href="javascript:document.ContactForm.reset();" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('Image1','','images/clear_over.gif',1)"><img src="images/clear.gif" alt="Clear" name="Image1" border="0"></a></td>
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