Contact The Jills Group

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.buttons a.over{background-position:-11px 0;} div.slider .thumbnail-scroller .buttons a.select{background-position:-22px 0;} /* END OF THUMBNAIL SCROLLER BUTTONS */ /* THUMBNAIL SCROLLER SCROLLBAR */ div.slider .thumbnail-scroller.horizontal .scrollbar{margin-top:30px;} div.slider .thumbnail-scroller.vertical .scrollbar{margin-left:30px;} /* END OF THUMBNAIL SCROLLER SCROLLBAR */</style><form name="form1" method="post" action="contact.asp?id=3251628"><input type="hidden" id="resiSecurityCode" name="resiSecurityCode" value="V4248O0N40S7" /><table width="710" cellpadding="1" cellspacing="2"><tr><td colspan="4" class="celltext" align="right" height="25" valign="middle"><a onClick="self.status='';return true;" onMouseOver="self.status='Return to the previous page';return true;" onMouseOut="self.status='';return true;" href="javascript:window.history.back()">< Back</a></td></tr><tr><td height="25" colspan="3" class="title">Contact Information</td></tr><td width="" rowspan="3" valign="top" class="celltext"><table width="100%" border="0" cellspacing="1" cellpadding="3"><tr><td class="text"><p><img alt="Coldwell Banker Residential RE | The Jills Group" src="http://www.thejills.com/megatemplate/uploads/rteul_images/10252013529012251.jpg" /></p><p>Coldwell Banker Residential RE | The Jills GroupHillary Hertzberg1682 Jefferson AveMiami Beach, FL 33139Phone: (305) 336-2210Fax (786) 276-7452Mobile (305) 336-2210<a href="mailto:hillary@thejills.com">hillary@thejills.com</a></p></td></tr></table></td><td valign="top" class="celltext"><table width="100%" border="0" cellspacing="0" cellpadding="3"><tr><td width="" class="textbold" colspan="2">Contact Form</td></tr><tr><td width="" style="white-space:nowrap" class="text">First Name<span style="color:red;"> *</span></td><td width="" class="text"><input name="FName" type="text" class="srhBox11" size="20"></td></tr><tr><td width="" style="white-space:nowrap" class="text">Last Name</td><td width="" class="text"><input name="LName" type="text" class="srhBox11" size="20"></td></tr><tr><td width="" style="white-space:nowrap" class="text">Email<span style="color:red;"> *</span></td><td width="" class="text"><input name="Email" type="text" class="srhBox11" size="20"></td></tr><tr><td width="" style="white-space:nowrap" class="text">Phone<span style="color:red;"> *</span></td><td width="" class="text"><input name="Phone1" type="text" class="srhBox11" size="20"></td></tr><tr><td width="" style="white-space:nowrap" class="text">Alt. Phone </td><td width="" class="text"><input name="Phone2" type="text" class="srhBox11" size="20"></td></tr><tr><td width="" style="white-space:nowrap" class="text">Best time to contact me</td><td width="" class="text"> <select name="BestTime" class="srhBox11"><option value="any">Any</option><option value="AM">AM</option><option value="PM">PM</option></select></td></tr><tr><td width="" style="white-space:nowrap" class="text" valign="top">Comments</td><td width="" class="text"><textarea name="Comments" cols="25" rows="4" wrap="physical" class="srhBox11"></textarea></td></tr></table></td></tr><tr><td class="celltext" colspan="1" width="301">* By submitting this form with your telephone number you are consenting for any and all authorized representatives of Coldwell Banker Residential RE | The Jills Group to contact you even if your name is on the <a href="https://www.donotcall.gov/default.aspx" target="_new">Federal Do-Not-Call List</a></td></tr><tr><td colspan="2" class="celltextcolor"><table width="15%" border="0" align="center" cellpadding="6" cellspacing="0"><tr><td width="21%"><input onClick="self.status='';return true;" onMouseOver="self.status='Click to begin search';return true;" onMouseOut="self.status='';return true;" type="image" src="images/submit_button.gif" name="Submit"></td><td width="79%"><a onClick="self.status='';return true;" onMouseOver="self.status='Click to reset form';return true;" onMouseOut="self.status='';return true;" href="contact.asp?Id=3251628"><img src="images/reset.gif" border="0"></a></td></tr></table></td></tr><tr><td height="100%" colspan="2" valign="top" class="celltext" align="center"><a href="http://www.resionline.com" target="_blank"><img src="images/resilogo.png" border="0"></a></td></tr></table></form>
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