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document.write('<!--AjaxQuick/webforms/Start form43350--><DIV name="w3scform" id="w3scform43350" class="w3sc43350_mainDiv"><a name="formTop43350"></a><img id="smokeScreen43350" src="https://www.w3now.com/srv/images/smoke.png" border="0" alt="" class="w3sc43350_smokeScreen" /><div ID="divLoadingSpace43350" class="w3sc43350_loading"><span class="w3sc43350_loadingtext"><img src="https://www.w3now.com/srv/images/ajax-loader.gif" width="28" height="28" alt="Sending..." align="absmiddle">Please wait</span></div><div ID="divErrSpace43350" class="w3sc43350_err"></div><FORM name="form43350" id="formid43350"><DIV class="w3sc43350_Selection_Block"><DIV class="w3sc43350_Option_Block"><div><label id="l16236" for="T_16236_33_1" class="w3sc43350_Label_Text">* Name:</label></div><!--AjaxQuick/webforms.Input--><div><INPUT id="T_16236_33_1" type="text" name="Selection_16236_10" onKeyUp="chkCharsLen(this,1000)" maxlength="1000" class="w3sc43350_Option_Block_Input" value="" /></div></DIV><DIV class="w3sc43350_Option_Block"><div><label id="l16239" for="T_16239_6_1" class="w3sc43350_Label_Text">* Phone Number:</label></div><!--AjaxQuick/webforms.Input--><div><INPUT id="T_16239_6_1" type="text" name="Selection_16239_20" onKeyUp="chkCharsLen(this,20)" maxlength="20" class="w3sc43350_Option_Block_Input" value="" /></div></DIV><DIV class="w3sc43350_Option_Block"><div><label id="l16235" for="T_16235_2_1" class="w3sc43350_Label_Text">* Email:</label></div><!--AjaxQuick/webforms.Input--><div><INPUT id="T_16235_2_1" type="text" name="Selection_16235_30" onKeyUp="chkCharsLen(this,1000)" maxlength="1000" class="w3sc43350_Option_Block_Input" value="" /></div></DIV><DIV class="w3sc43350_Option_Block"><div><label id="l16237" for="T_16237_48_1" class="w3sc43350_Label_Text">* Comments or Questions:</label></div><!--AjaxQuick/webforms.Textarea--><div><TEXTAREA ID="T_16237_48_1" name="Selection_16237_40" rows="6" onKeyUp="chkCharsLen(this,2000,\'chars_16237\',\'html\')" class="w3sc43350_Option_Block_Textarea"></TEXTAREA></div><div class="w3sc43350_Option_Text_Div" style="margin:2px 0 2px 2px;"><span id="charCountNoteField43350" class="w3sc43350_Option_NoteText">Max 2000 characters.&nbsp;<span ID="chars_16237" style="padding:1px;border:1px solid #cccccc;">0</span></span></div></DIV><DIV class="w3sc43350_Option_Block"><div ID="divSubmitButton43350" align="center"><input type="button" value="&nbsp;Submit&nbsp;" name="submitbutton" onClick="SubmitFormAjax(document.getElementById(\'formid43350\'),43350,\'28F33618-5056-A02D-9C79DC73778FF4BC\',\'https://www.w3now.com\',\'CFM\',\'\',1);" class="w3sc43350_Submit_Button_Text" /></div></DIV></DIV><INPUT TYPE="hidden" NAME="action" VALUE="add" /><INPUT TYPE="hidden" NAME="ItemNumber" value="43350" /><INPUT TYPE="hidden" NAME="Cat" VALUE="5900" /><input type="hidden" name="wspk_1_16236" value="1"><input type="hidden" name="wspk_1_16239" value="1"><input type="hidden" name="wspk_1_16235" value="1"><input type="hidden" name="wspk_1_16237" value="1"><input type ="hidden" name="wtitle_Selection_16236_10" value="Name:"><input type ="hidden" name="wtitle_Selection_16239_20" value="Phone Number:"><input type ="hidden" name="wtitle_Selection_16235_30" value="Email:"><input type ="hidden" name="wtitle_Selection_16237_40" value="Comments or Questions:"><INPUT TYPE="hidden" NAME="returnToURL" VALUE="https://w3safesecure.us/trurealestateservices" /><INPUT TYPE="hidden" NAME="returnToShop" value="https://w3safesecure.us/trurealestateservices" /><INPUT TYPE="hidden" NAME="Admitu" VALUE="28F33618-5056-A02D-9C79DC73778FF4BC" /></FORM></DIV><!--AjaxQuick/webforms/end form43350-->');