YOUR NAME
START ZIP CODE
END ZIP CODE
EMAIL
PHONE #
MOVE TYPE	1 BR Upper Apt 1 BR Lower Apt 2 BR Upper Apt 2 BR Lower Apt 3 BR Upper Apt 3 BR Lower Apt 4 BR Upper Apt 4 BR Lower Apt 1 BR House 2 BR House 3 BR House 4 BR House Other
MOVE DATE
COMMENTS
ANTI-SPAM	TYPE "LCM"