When do you plan to sell?

            Address of home you wish to sell:   (Required to provide accurate market data)

            Estimated value of the home you wish to sell:

            Would you like Jan to personally look at your home?

Yes
No

           Would you like a Computerized Market Analysis?

Yes
No

           How would you like the Market Analysis Delivered?

E-Mailed Sent via US Mail Hand Delivered FAXED to me (Choose an option.)

First Name
Last Name	(optional)
	Address below is where the material will be sent.
Address
City
State	Zip
Phone	(Please include the area code.)
E-Mail

           Is there anything else that you need to tell Jan?    (Optional)