Dear FullName ,

Thank you for sending us your request for a Agent. You have asked us to contact you, we will be using the following information:

          Street: StreetAddress
          City:      City State:   State Zip: ZipCode
          Phone Work: WorkPhone Home: HomePhone Cell: CellPhone FAX FAX
          e-Mail: EmailAddress

e-mail: EmailAddress
Telephone: HomePhone
FAX: FAX

If any of this information is incorrect, please go back to the form and change it. We thank you for taking the time to help us be a better company.  Someone will contact you shortly.

Sincerely,

Pat Kelly
Real Estate Consultant

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Revised: July 28, 2004 .