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Your name
(first, last)
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Your home city (province) and country
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Your e-mail address
(exact please)
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How did you find us?
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if other please specify
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Your phone no.
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Your fax no.
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Have you visited Costa Rica before?
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Are you planning to visit Costa Rica?
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What type of property are you interested in?
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What is your price range?
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Additional comments
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