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			<h3 style="text-align: center;">Are you ready to find out what your home is worth?</h3>
<p style="text-align: center;">Tell us about your place and we&#8217;ll get back to you!</p>
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	  	<input type="hidden" name="form_id" value="2" /><fieldset class="vfb-fieldset vfb-fieldset-1 17 " id="item-vfb-17">&nbsp;<ul class="vfb-section vfb-section-1"><div id="item-vfb-26" class="vfb-section-div "><h4>Contact Information</h4></div><div class="vfb-clear"></div><li class="vfb-item vfb-item-text  " id="item-vfb-21"><label for="vfb-21" class="vfb-desc">Name  <span class="vfb-required-asterisk">*</span></label><input type="text" name="vfb-21" id="vfb-21" value="" class="vfb-text  vfb-large  required  " /></li><li class="vfb-item vfb-item-email  " id="item-vfb-22"><label for="vfb-22" class="vfb-desc">Email  <span class="vfb-required-asterisk">*</span></label><input type="email" name="vfb-22" id="vfb-22" value="" class="vfb-text  vfb-large  required  email " /></li><li class="vfb-item vfb-item-phone  " id="item-vfb-23"><label for="vfb-23" class="vfb-desc">Phone  <span class="vfb-required-asterisk">*</span></label><input type="tel" name="vfb-23" id="vfb-23" value="" class="vfb-text  vfb-large  required  phone " /></li><li class="vfb-item vfb-item-address  " id="item-vfb-24"><label class="vfb-desc">Address </label><div><span class="vfb-full"><input type="text" name="vfb-24[address]" id="vfb-24-address" maxlength="150" class="vfb-text vfb-medium  " /><label for="vfb-24-address">Street Address</label></span><span class="vfb-full"><input type="text" name="vfb-24[address-2]" id="vfb-24-address-2" maxlength="150" class="vfb-text vfb-medium  " /><label for="vfb-24-address-2">Apt, Suite, Bldg. (optional)</label></span><span class="vfb-left"><input type="text" name="vfb-24[city]" id="vfb-24-city" maxlength="150" class="vfb-text vfb-medium  " /><label for="vfb-24-city">City</label></span><span class="vfb-right"><input type="text" name="vfb-24[state]" id="vfb-24-state" maxlength="150" class="vfb-text vfb-medium  " /><label for="vfb-24-state">State / Province / Region</label></span><span class="vfb-left"><input type="text" name="vfb-24[zip]" id="vfb-24-zip" maxlength="150" class="vfb-text vfb-medium  " /><label for="vfb-24-zip">Postal / Zip Code</label></span><span class="vfb-right"><select name="vfb-24[country]" class="vfb-select  " id="vfb-24-country"><option value="" selected='selected'></option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas">Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="China">China</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo (Brazzaville)">Congo (Brazzaville)</option><option value="Congo">Congo</option><option value="Costa Rica">Costa Rica</option><option value="Cote d\'Ivoire">Cote d\'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="East Timor (Timor Timur)">East Timor (Timor Timur)</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Ethiopia">Ethiopia</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="Gabon">Gabon</option><option value="Gambia, The">Gambia, The</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Greece">Greece</option><option value="Grenada">Grenada</option><option value="Guatemala">Guatemala</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="Korea, North">Korea, North</option><option value="Korea, South">Korea, South</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palestinian Territory">Palestinian Territory</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Vincent">Saint Vincent</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="South Africa">South Africa</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Togo">Togo</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="United States of America">United States of America</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="Western Sahara">Western Sahara</option><option value="Western Samoa">Western Samoa</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option></select><label for="vfb-24-country">Country</label></span></div></li><li class="vfb-item vfb-item-date  " id="item-vfb-25"><label for="vfb-25" class="vfb-desc">Approximate Date of Move </label><input type="text" name="vfb-25" id="vfb-25" value="" class="vfb-text vfb-date-picker  vfb-large  " data-dp-dateFormat="mm/dd/yy" /></li><div id="item-vfb-27" class="vfb-section-div "><h4>Home Specifications</h4></div><div class="vfb-clear"></div><li class="vfb-item vfb-item-checkbox  " id="item-vfb-29"><label class="vfb-desc">Type of Property  <span class="vfb-required-asterisk">*</span></label><div><span class="vfb-span"><input type="checkbox" name="vfb-29[]" id="vfb-29-0" value="Single Family Home" class="vfb-checkbox  required " /><label for="vfb-29-0" class="vfb-choice">Single Family Home</label></span><span class="vfb-span"><input type="checkbox" name="vfb-29[]" id="vfb-29-1" value="Condominium/Townhome" class="vfb-checkbox  required " /><label for="vfb-29-1" class="vfb-choice">Condominium/Townhome</label></span><span class="vfb-span"><input type="checkbox" name="vfb-29[]" id="vfb-29-2" value="Income Property" class="vfb-checkbox  required " /><label for="vfb-29-2" class="vfb-choice">Income Property</label></span><div style="clear:both"></div></div></li><li class="vfb-item vfb-item-checkbox  " id="item-vfb-30"><label class="vfb-desc">Bedrooms  <span class="vfb-required-asterisk">*</span></label><div><span class="vfb-span"><input type="checkbox" name="vfb-30[]" id="vfb-30-0" value="1" class="vfb-checkbox  required " /><label for="vfb-30-0" class="vfb-choice">1</label></span><span class="vfb-span"><input type="checkbox" name="vfb-30[]" id="vfb-30-1" value="2" class="vfb-checkbox  required " /><label for="vfb-30-1" class="vfb-choice">2</label></span><span class="vfb-span"><input type="checkbox" name="vfb-30[]" id="vfb-30-2" value="3" class="vfb-checkbox  required " /><label for="vfb-30-2" class="vfb-choice">3</label></span><span class="vfb-span"><input type="checkbox" name="vfb-30[]" id="vfb-30-3" value="4" class="vfb-checkbox  required " /><label for="vfb-30-3" class="vfb-choice">4</label></span><span class="vfb-span"><input type="checkbox" name="vfb-30[]" id="vfb-30-4" value="5+" class="vfb-checkbox  required " /><label for="vfb-30-4" class="vfb-choice">5+</label></span><div style="clear:both"></div></div></li><li class="vfb-item vfb-item-checkbox  " id="item-vfb-31"><label class="vfb-desc">Bathrooms  <span class="vfb-required-asterisk">*</span></label><div><span class="vfb-span"><input type="checkbox" name="vfb-31[]" id="vfb-31-0" value="1" class="vfb-checkbox  required " /><label for="vfb-31-0" class="vfb-choice">1</label></span><span class="vfb-span"><input type="checkbox" name="vfb-31[]" id="vfb-31-1" value="2" class="vfb-checkbox  required " /><label for="vfb-31-1" class="vfb-choice">2</label></span><span class="vfb-span"><input type="checkbox" name="vfb-31[]" id="vfb-31-2" value="3+" class="vfb-checkbox  required " /><label for="vfb-31-2" class="vfb-choice">3+</label></span><div style="clear:both"></div></div></li><li class="vfb-item vfb-item-text  " id="item-vfb-28"><label for="vfb-28" class="vfb-desc">Square Footage </label><input type="text" name="vfb-28" id="vfb-28" value="" class="vfb-text  vfb-large   " /></li><li class="vfb-item vfb-item-textarea  " id="item-vfb-32"><label for="vfb-32" class="vfb-desc">Additional Comments </label><div><textarea name="vfb-32" id="vfb-32" class="vfb-textarea  vfb-large  "></textarea></div></li></ul>&nbsp;</fieldset><fieldset class="vfb-fieldset vfb-fieldset-2 verification " id="item-vfb-18" style="display:block"><div class="vfb-legend"><h3>Verification</h3></div><ul class="vfb-section vfb-section-2"><li class="vfb-item vfb-item-secret"  style="display:block"><label for="vfb-19" class="vfb-desc">Please enter any two digits <span class="vfb-required-asterisk">*</span></label><input type="hidden" name="_vfb-secret" value="vfb-19" /><span class="vfb-span"><input type="text" name="vfb-19" id="vfb-19" value="" class="vfb-text  vfb-medium  required {digits:true,maxlength:2,minlength:2} " style="display:block" /><label>Example: 12</label></span><li style="display:none;"><label>This box is for spam protection - &lt;strong&gt;please leave it blank&lt;/strong&gt;:</label><div><input name="vfb-spam" /></div></li>
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