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        <link id="_injection_graph_nh_css" class="skype_name_highlight_style" rel="stylesheet" type="text/css" href="chrome://skype_ff_toolbar_win/content/injection_nh_graph.css" charset="utf-8">
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        <form id="Contact Us" onsubmit="MM_validateForm('txtEmail','','RisEmail');return document.MM_returnValue" method="post" name="Contact Us" action="http://post.clphome.com/wcmpost.aspx">
            <div align="center"></div>
            <table style="border-collapse: collapse; font-family: Verdana; font-size: 12px;" align="center" border="0" cellpadding="0" cellspacing="0" width="800">
                <tbody>
                    <tr align="middle">
                        <td style="padding-bottom: 15px;" colspan="2">&nbsp;<a href="http://www.garywelchhomeloans.com/" target="_blank"><img alt="GWHL logo" src="http://www.garywelchhomeloans.com/branding/images/LogoGreen_483.jpg" border="0"></a></td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 15px;" colspan="2"><span style="font-size: 12pt;">
                        <p align="center"><strong><br>
                        Refer-a-Friend</strong></p>
                        </span></td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 10px; padding-top: 10px;" colspan="2" valign="center"><font style="font-size: 8pt;">We appreciate your referral!!<br>
                        &nbsp;<br>
                        Please fill out the form below, and if you have any question do&nbsp;not hesitate to&nbsp;contact me directly at 770.888.2232 or <a href="mailto:gary@garywelchhomeloans.com">gary@garywelchhomeloans.com</a>.</font></td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 10px; padding-top: 10px;" colspan="2" valign="center">
                        <hr width="100%" size="1">
                        </td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 10px; padding-top: 10px;" colspan="2" valign="center">
                        <table>
                            <tbody>
                                <tr>
                                    <td><br>
                                    </td>
                                    <td><font style="font-size: 9pt;"><span style="text-decoration: underline;">Your Information</span></font></td>
                                    <td><br>
                                    </td>
                                    <td><font style="font-size: 9pt;"><span style="text-decoration: underline;">Information on Your Referral</span></font></td>
                                </tr>
                                <tr>
                                    <td align="left" valign="center"><font style="font-size: 8pt;">*Your Full Name:</font></td>
                                    <td><input style="width: 175px;" name="txtCustom16" dpieagent_iecontroltype="2"><font style="font-size: 9pt;">&nbsp;</font></td>
                                    <td align="left" valign="center"><font style="font-size: 8pt;">*Referral First Name&nbsp;</font></td>
                                    <td><font style="font-size: 9pt;"><input style="width: 175px; height: 22px;" name="txtFirstName" dpieagent_iecontroltype="2"></font></td>
                                </tr>
                                <tr>
                                    <td><font style="font-size: 8pt;">*Your Email:</font></td>
                                    <td><input style="width: 225px;" name="txtNote1" dpieagent_iecontroltype="2"><font style="font-size: 9pt;"></font></td>
                                    <td><font style="font-size: 8pt;">*Referral Last Name</font></td>
                                    <td><font style="font-size: 9pt;"><input style="width: 175px; height: 22px;" name="txtLastName" dpieagent_iecontroltype="2"></font></td>
                                </tr>
                                <tr>
                                    <td><font style="font-size: 8pt;">*Relationship to Referral:</font></td>
                                    <td><input style="width: 225px;" name="txtNote2" dpieagent_iecontroltype="2"><font style="font-size: 9pt;"></font></td>
                                    <td><font style="font-size: 8pt;">*Referral Email</font></td>
                                    <td><input style="width: 225px; height: 22px;" name="txtEmail" dpieagent_iecontroltype="2"></td>
                                </tr>
                            </tbody>
                        </table>
                        <br>
                        <hr width="100%" size="1">
                        </td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 10px; padding-top: 10px;" colspan="2" valign="center"><font style="font-size: 9pt;"><span style="text-decoration: underline;">Optional Information on Referral</span></font></td>
                    </tr>
                    <tr>
                        <td><font style="font-size: 8pt;">Street Address:</font></td>
                        <td style="padding-bottom: 5px; padding-top: 5px;"><input style="width: 175px; height: 22px;" name="txtAdd1" dpieagent_iecontroltype="2"></td>
                    </tr>
                    <tr>
                        <td><font style="font-size: 8pt;">City, ST, Zip:</font></td>
                        <td style="padding-bottom: 5px; padding-top: 5px;"><input style="width: 175px; height: 22px;" name="txtCity" dpieagent_iecontroltype="2">&nbsp; <input style="width: 100px; height: 22px;" name="txtState" dpieagent_iecontroltype="2">&nbsp; <input style="width: 100px; height: 22px;" name="txtZip" dpieagent_iecontroltype="2"></td>
                    </tr>
                    <tr>
                        <td><font style="font-size: 8pt;">Phone:</font></td>
                        <td style="padding-bottom: 5px; padding-top: 5px;"><input style="width: 175px;" name="txtPhone" dpieagent_iecontroltype="2"></td>
                    </tr>
                    <tr>
                        <td>Contact Preference:</td>
                        <td style="padding-bottom: 5px; padding-top: 5px;">Phone&nbsp;<input value="Phone" name="txtNote5" type="radio">&nbsp;&nbsp; &nbsp;Email&nbsp;<input value="Email" name="txtNote5" type="radio">&nbsp;&nbsp;&nbsp; N/A <input value="N/A" name="txtNote5" type="radio"></td>
                    </tr>
                    <tr>
                        <td style="padding-bottom: 10px; padding-top: 10px;" colspan="2" valign="center">
                        <table>
                            <tbody>
                                <tr>
                                    <td><font style="font-size: 8pt;">Referral Interest/Need:</font></td>
                                    <td><font style="font-size: 8pt;">&nbsp;Refinance <input value="Refinance" name="txtNote3" type="radio"></font></td>
                                    <td><font style="font-size: 8pt;">&nbsp;<font style="font-size: 8pt;">Purchase&nbsp; </font><input value="Purchase" name="txtNote3" type="radio">&nbsp; </font></td>
                                    <td><font style="font-size: 8pt;">&nbsp;General Inquiry </font><font style="font-size: 8pt;"><input value="General Inquiry" name="txtNote3" type="radio"></font></td>
                                    <td><font style="font-size: 8pt;">&nbsp;Other </font><font style="font-size: 8pt;"><input value="Other" name="txtNote3" type="radio"></font></td>
                                </tr>
                            </tbody>
                        </table>
                        </td>
                    </tr>
                    <tr>
                        <td style="padding-top: 5px;" valign="top" width="18%"><font style="font-size: 8pt;">Comments on Referral:</font></td>
                        <td style="padding-bottom: 5px; padding-top: 5px;" valign="top"><textarea style="width: 600px;" rows="8" cols="48" name="txtNote4"></textarea></td>
                    </tr>
                    <tr>
                        <td style="padding-top: 20px;" colspan="2">
                        <p align="center">&nbsp;&nbsp;<input style="width: 100px; height: 22px;" value="SOR Email" name="txtNote1Title" type="hidden">&nbsp;<input style="width: 100px; height: 22px;" value="SOR Relationship to Referral" name="txtNote2Title" type="hidden">&nbsp;<input style="width: 100px; height: 22px;" value="Referral's Contact Preference" name="txtNote5Title" type="hidden">&nbsp;<input style="width: 100px; height: 22px;" value="Referral's Interest/Need" name="txtNote3Title" type="hidden">&nbsp;<input style="width: 100px; height: 22px;" value="Comments on Referral" name="txtNote4Title" type="hidden"> <input value="http://www.garywelchhomeloans.com/" name="RedirectURL" type="hidden"> <input id="Submit" value="Refer Now" name="Submit" type="submit"><input value="IENTG1LWBUERFVUUXDG7V15WZKON" name="LinkCode" type="hidden"> </p>
                        </td>
                    </tr>
                    <tr>
                        <td style="padding-top: 20px;" colspan="2"><font style="font-size: 8pt;"><a href="http://www.garywelchhomeloans.com/" target="_blank">Return to</a></font>&nbsp; <a href="http://www.garywelchhomeloans.com/" target="_blank"><img style="width: 170px; height: 21px;" alt="GWHL button" src="http://www.garywelchhomeloans.com/emailupdates/images/btnGaryWelch.jpg" align="absMiddle" border="0"></a></td>
                    </tr>
                </tbody>
            </table>
        </form>
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