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305.333.6100   |   llkennedy@cbschmitt.com

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text-align: center;"><table cellpadding="1" cellspacing="2" style="float: left; clear: left; width: auto;"><tr><td colspan="2" class="celltextBOLD" height="25">Login Information:</td></tr><tr><td class="celltextcolor" align="right" width="130" height="25">*User Name:</td><td class="celltext" height="25"><input name="LoginName" class="srhBox" maxlength="20" size="20" tabindex="1" value="" type="text"></tr><tr><td class="celltextcolor" align="right" height="25">*Password:</td><td class="celltext" height="25"><input name="Password" type="password" class="srhBox" size="20" tabindex="2" maxlength="20" value=""></td></tr><tr><td nowrap class="celltextcolor" align="right" height="25">*Confirm Password:</td><td class="celltext" height="25"><input name="ConfirmPassword" type="password" class="srhBox" tabindex="3" size="20" maxlength="20" value=""></td></tr></table><table cellpadding="1" cellspacing="2" style="float: left; clear: right;width: auto;"><tr><td colspan="2" class="celltextBOLD" height="25">Personal Information:</td></tr><tr><td class="celltextcolor" align="right" height="25">*First Name:</td><td class="celltext" height="25"><input name="FirstName" class="srhBox" maxlength="20" size="20" tabindex="4" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">*Last Name:</td><td class="celltext" height="25"><input name="LastName" class="srhBox" size="20" maxlength="20" tabindex="5" value=""></td></tr><tr><td nowrap class="celltextcolor" align="right" height="25">*Email Address:</td><td class="celltext" height="25"><input name="EmailAddress" class="srhBox" size="25" tabindex="6" maxlength="50" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">*Category:</td><td class="celltext" height="25"><select name="Category" size="1"><option value="">Select One</option><option value="Buyer" >Buyer</option><option value="Seller" >Seller</option><option value="Investor" >Investor</option><option value="First-time Home Buyer" >First-time Home Buyer</option><option value="Relocation" >Relocation</option><option value="Other" >Other</option></select></td></tr><tr><td class="celltextcolor" align="right" height="25">Address:</td><td class="celltext" height="25"><input name="Address" class="srhBox" size="25" tabindex="7" maxlength="30" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">City:</td><td class="celltext" height="25"><input name="City" class="srhBox" size="20" tabindex="8" maxlength="15" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">State:</td><td class="celltext" height="25"><input name="State" class="srhBox" size="3" tabindex="9" maxlength="2" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">Zip Code:</td><td class="celltext" height="25"><input name="ZipCode" class="srhBox" size="5" tabindex="10" maxlength="5" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">Country:</td><td class="celltext" height="25"><input class="srhBox" name="Country" size="20" tabindex="11" maxlength="10" value=""></td></tr><tr><td class="celltextcolor" align="right" height="25">*Phone:</td><td class="celltext" height="25"><input class="srhBox" name="Phone" size="20" tabindex="12" maxlength="18" value=""></td></tr></table></td></tr><tr><td colspan="4" valign="top" class="celltext"><table width="100%" border="0" cellspacing="0" cellpadding="3"><tr><td width="70%" class="text">Send me information about new listings.</td><td width="10%" class="text">NO <input type="radio" value="" name="ReceiveInfo" tabindex="13" checked></td><td width="10%" class="text">YES <input type="radio" value="checkbox" name="ReceiveInfo" checked></td><td> </td></tr></table></td></tr><tr><td colspan="4" class="celltextcolor"><table width="15%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td width="21%"><input type="image" src="images/submit_button.gif" tabindex="16"></td><td width="79%"><a href="javascript:form1.reset()" tabindex="15"><img src="images/reset.gif" height="22" border="0"></a></td></tr></table></td></tr><tr><td colspan="4" height="100%" valign="top" class="celltext"> </td></tr><tr><td colspan="4" valign="top" class="celltext"><table width="100%" height="100%" border="0" cellpadding="3" cellspacing="0"><tr><td valign="top" align="center" class="textHF"></td></tr></table></td></tr><tr><td height="" colspan="4" valign="top" class="celltext" align="center"><a href="http://www.resionline.com" target="_blank"><img src="../megatemplate/images/resilogo.png" alt="Real Estate Web Design" width="96" height="39" border="0"></a></td></tr></table><input type="hidden" name="strAction" value="Submit"></form>
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