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By Phone: (203) 256-0589  By Fax: (203) 259-0514  By Mail: 1st Option Realty 1330 Post Road, Suite 3 Fairfield, CT 06824 By E-Mail Please complete the following form (* = Field Required for Response) 1. How can we Help?* I want to list my home for sale I want to speak to someone before listing I want to buy a home - Please contact me I am a builder interested in your builder programs Other 2. How soon do you plan to buy or sell? Immediately Within the Next 30 Days Within 2 to 6 Months More Than 6 Months 3. How did you hear about 1st Option Realty? Search Engine Another Web Site Billboard E-mail Newspaper or Magazine Ad Newspaper or Magazine Article Post Card or Letter Radio Referal from Friend Television Telemarketing 4. Primary Contact First Name & Middle Initial* 5. Primary Contact Last Name* 6. Street Address 7. Unit Number 8. City 9. State 10. Zip Code 11. Daytime Telephone 12. Evening Phone 13. E-mail Address* 14. Additional comments or questions*

1st Option is truly your . . . "first option" . . . to the traditional real estate company that charges you thousands of dollars in commissions without the added benefits you get with 1st Option Realty.

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1st Option Realty, 1330 Post Road, Suite 3, Fairfield, CT 06824