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<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="043fd5a3.jpg"> <div> <FONT SIZE="5" COLOR="#993366" FACE="Bart" ><B>Cork Poppers </B></FONT><FONT SIZE="4" COLOR="#990099" FACE="Bavand" ><B>Fine Wine & Spirits</B></FONT><B>    </B><B> |  </B><FONT SIZE="4" COLOR="#990033" FACE="Bangle" ><B>  </B><A HREF="index.htm" TARGET="_top" TITLE="Cork Poppers "><U><B>HOME</B></U></A></FONT></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="About Us"><U>About Us</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="News and Events"><U>News and Events</U></A>   |   <A HREF="id29.htm" TARGET="_top" TITLE="Wine Of The Month Club"><U>Wine Of The Month Club</U></A>   |   <B>Join Our Mailing List</B>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Location"><U>Location</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Our Products and Services"><U>Our Products and Services</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Links"><U>Links</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Orders"><U>Orders</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="044d2b03.jpg"> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Join Our Mailing List</I></div> <DIV ALIGN="LEFT"></DIV> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,City,State,Zip,Phone,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your joining our mailing list."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="pike@corkpoppers.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>