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*	Name
*	Address
*	Email
*	City
*	State / Province
*	country	Select country Canada United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
*	Zip/Postal Code
*	Home Phone
	Cell Phone
	Home Criteria
*	location	Please Select Cedar/Cranberry Central Nanaimo Chase River Departure Bay Diver Lake Hammond Bay Jinglepot Lower Lantzville North Nanaimo Old City Pleasant Valley South Nanaimo Uplands Upper Lantzville
*	Property Type	Please Select Duplex ½ Duplex> Condominium Townhouse Rancher 2 Story Farm/Ranch
*	Bedrooms	>Please Select 1 2 3 4 5
*	Bathrooms	>Please Select 1 2 3 4 5
	Ocean View	>Please Select Don't Care Yes No
	Mountain View	>Please Select Don't Care Yes No
	Waterfront - Ocean	>Please Select Don't Care Yes No
	Wheelchair Accessibility	>Please Select Don't Care Yes No
	Workshop	>Please Select Don't Care Yes No
	Gararge	>Please Select Don't Care Yes No
	Fire Place	>Please Select Don't Care Yes No
*	Price from	Please Select 100000 125000> 150000 175000 200000 225000 250000 275000 300000> 350000 375000 400000 425000 450000 475000 500000> 550000 600000 650000 700000 750000 800000 850000> 900000 1000000 1250000 1500000 1750000 2000000 over
*	Price to	Please Select 100000 125000> 150000 175000 200000 225000 250000 275000 300000> 350000 375000 400000 425000 450000 475000 500000> 550000 600000 650000 700000 750000 800000 850000> 900000 1000000 1250000 1500000 1750000 2000000 over
*	Do you Currently have a Agent?	>Please Select Yes No
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