Contact Dominical Dot Biz
Select PropertiesBy Phone (011) 506-8-816-9444
By Email benvaughn@gmail.comClick to E-mail
By Mail: APDO 84-8000 / San Isidro de P.Z. Costa Rica
We look forward to hearing from you!
| Your name * | ||||
| Your contact e-mail * | ||||
| How did you find us? | Choose Yahoo AOL Google Ask Jeeves MSN Word of mouth Other if other, please specfiy | |||
| If via the Internet, what keywords did you use? | ||||
| Your contact phone # * | ||||
| Have you visited Costa Rica before? | YES NO | |||
| Are you planning to visit Costa Rica? | Choose No, I'm not planning a trip yet I'm visiting in 1 month I'm visiting in 1-3 months I'm visiting in 3-6 months I'm already in Costa Rica | |||
| How soon do you plan to purchase/rent property in Costa Rica? | Just browsing 6 months-1 year 2-4 months 1-2 months immediately | |||
| Select all that apply | Ocean View | Waterfall | Valley View | Reforestation |
| What type of property are you interested in? * | ||||
| Select One Lots for sale Commercial property House Condominium Development Land Other | ||||
| What is your price range? | Choose under $70,000 $70,000-$150,000 $150,000-$250,000 $250,000-$400,000 $400,000-$600,000 $600,000-$1,000,000 $1,000,000 and up | |||
| Use this area for informative comments about how we might be of service for you. | <H3>Contact Dominical Dot Biz</h3><B>Select Properties</b> <P>By Phone (011) 506-8-816-9444<BR>By Email benvaughn@gmail.com<A href="mailto:benvaughn@gmail.com">Click to E-mail</a><BR> By Mail: APDO 84-8000 / San Isidro de P.Z. Costa Rica<br />We look forward to hearing from you!</p><BR> <div align="left"> <form name="Interno"action="/cgi-sys/formmail.pl" method="POST"> <input type="hidden" name="required" value="realname, email, phone,property_type"> <input type="hidden" name="subject" value="Dominical.biz Real Estate Info Request"> <input type="hidden" name="recipient" value="ben@hotcostaricarealestate.com"> <input type="hidden" name="redirect" value="http://www.hotcostaricarealestate.com/index.php?action=page_display&PageID=50"> <input type="hidden" name="missing_fields_redirect" value="http://www.hotcostaricarealestate.com/index.php?action=page_display&PageID=51"> <center> <table border="0" width="100%" cellpadding="2" cellspacing="3"> <tr> <td width="33%" class="bgliteyell">Your name *</td> <td width="296" colspan="4" class="bgliteyell"><input type="text" name="realname" size="45"> </td> </tr> <tr> <td width="33%" class="txtyell">Your contact e-mail *</td> <td width="296" colspan="4"><input type="text" name="email" size="44"> </td> </tr> <tr> <td width="33%" class="bgliteyell">How did you find us?</td> <td width="296" colspan="4" class="bgliteyell"><select name="how_found" size="1"> <option>Choose</option> <option value="Yahoo">Yahoo</option> <option value="AOL">AOL</option> <option value="Google">Google</option> <option value="Ask Jeeves">Ask Jeeves</option> <option value="MSN">MSN</option> <option value="Word of mouth">Word of mouth</option> <option value="Other">Other </option> </select> <br> if other, please specfiy <input type="text" name="if_other" size="30"> </td> </tr> <tr> <td width="33%" class="txtyell">If via the Internet, what keywords did you use?</td> <td width="296" colspan="4"><input type="text" name="keywords" size="45"> </td> </tr> <tr> <td width="33%" class="bgliteyell">Your contact phone # *</td> <td width="296" colspan="4" class="bgliteyell"><input type="text" name="phone" size="31"> </td> </tr> <tr> <td width="33%" class="txtyell">Have you visited Costa Rica before?</td> <td width="296" colspan="4" align="left"><input type="checkbox" name="Visited_CR" value="Yes"> YES <input type="checkbox" name="Visited_CR" value="No"> NO</td> </tr> <tr> <td width="33%" class="bgliteyell">Are you planning to visit Costa Rica?</td> <td width="296" colspan="4" class="bgliteyell"><select name="coming_to_CR" size="1"> <option>Choose</option> <option value="No_I'm_not_planning_a_trip_yet">No, I'm not planning a trip yet</option> <option value="I'm_visiting_in_1_month">I'm visiting in 1 month</option> <option value="I'm_visiting_in_1-3_months">I'm visiting in 1-3 months</option> <option value="I'm_visiting_in_3-6_months">I'm visiting in 3-6 months</option> <option value="I'm_already_in_Costa_Rica">I'm already in Costa Rica </option> </select> </td> </tr> <tr> <td width="33%" class="txtyell">How soon do you plan to purchase/rent property in Costa Rica?</td> <td width="296" colspan="4"><select name="purchase_soon" size="1"> <option value="Just browsing">Just browsing</option> <option value="6 months-1 year">6 months-1 year</option> <option value="2-4 months">2-4 months</option> <option value="1-2 months">1-2 months</option> <option value="immediately">immediately </option> </select> </td> </tr> <tr> <td width="33%" class="bgliteyell">Select all that apply </td> <td width="32" class="bgliteyell">Ocean View </td> <td width="35" class="bgliteyell">Waterfall</td> <td width="72" class="bgliteyell">Valley View</td> <td width="148" class="bgliteyell">Reforestation</td> </tr> <tr> <td width="33%" rowspan="2" class="bgliteyell">What type of property are you interested in? * </td> <td align="center" class="bgliteyell"><label> <input type="checkbox" name="oceanview" value=" oceanview"> </label></td> <td align="center" class="bgliteyell"><label> <input type="checkbox" name="waterfall" value="waterfall"> </label></td> <td align="center" class="bgliteyell"><input type="checkbox" name="valleyview" value="valleyview"></td> <td align="center" class="bgliteyell"><input type="checkbox" name="reforestation" value="reforestation"></td> </tr> <tr> <td colspan="4" align="center" class="bgliteyell"><select name="property_type" size="1"> <option value="">Select One</option> <option value="Lots for sale">Lots for sale</option> <option value="Commercial property">Commercial property</option> <option value="House">House</option> <option value="Condominium">Condominium</option> <option value="Development Land">Development Land</option> <option value="Other">Other</option> </select></td> </tr> <tr> <td width="33%" class="bgliteyell">What is your price range?</td> <td width="296" colspan="4" align="center" class="bgliteyell"><select name="pricerange" size="1"> <option>Choose</option> <option value="under $70,000">under $70,000</option> <option value="$70,000-$150,000">$70,000-$150,000</option> <option value="150,000-$250,000">$150,000-$250,000</option> <option value="$250,000-$400,000">$250,000-$400,000</option> <option value="$400,000-$600,000">$400,000-$600,000</option> <option value="$600,000-$1,000,000">$600,000-$1,000,000</option> <option value="$1,000,000 and up ">$1,000,000 and up </option> </select> </td> </tr> <tr> <td width="33%" valign="top" class="txtyell">Use this area for informative comments about how we might be of service for you. </td> <td width="296" colspan="4"><textarea rows="6" name="Message" cols="45"> <!-- <h3>Contact Seabreeze</h3><b>Select Properties</b> <p>By Email beajazz@aol.com<a href="mailto:beajazz@aol.com"> Click to E-mail</a><br />By Mail: APDO 84-8000 / San Isidro de P.Z. Costa Rica<br />We look forward to hearing from you!</p><br /> <div align="left"> <p> </p></div>--> | |||