Please fill in this form and a broker will get back to you promptly.<br /><br />
<div id="propValBox">
	<form id="propValForm" name="propValForm" onsubmit="return false;">
		<label>Name</label><input type="text" id="name" name="name" value="" /><br class="clear" />
		<label>Email</label><input type="text" id="email" name="email" value="" /><br class="clear" />
		<label>Property Address</label><textarea id="message" name="message"></textarea><br class="clear" />
		<div style="padding:10px;text-align:center;"><input onclick="submitForm();" type="button" name="submit" value="Submit" /></div>
	</form>
</div>