Wine Of The Month Club

<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>   |   <B>Wine Of The Month Club</B>   |   <A HREF="id28.htm" TARGET="_top" TITLE="Join Our Mailing List"><U>Join Our Mailing List</U></A>   |   <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>Wine Of The Month Club</I></div> <div> <IMG SRC="29d2bba0.png" border=0 width="555" height="186" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Join For As Many Months As You Like </div> <div> - 3 Months Minimum To Join</div> <bR> <div> 3 Levels Of Entry To Chose From</div> <div> Each Package Includes 2 Bottles Of Wine</div> <bR> <div> Package (A) $35.00 A Month</div> <div> Package (B) $75.00 A Month</div> <div> Package (C) $125.00 A Month</div> <bR> <div> The Exact Contents Of Each Package Will Be Chosen By Our Staff For You, Or Your Gift Recipient</div> <div> Simply Fill Out The Form Below To Join</div> <div> Each Month,  Either Of The Wines Sent Can Be Purchased By The Case, At A 20% Discount For Wine Club Members During That Month</div> <div> Shipping Charges And Taxes Are Included - Or Pick - Up Your Wines In Our Store Each Month, Pre-Wrapped For You, And Receive A Discount.</div> <div> This Offer Cannot Be Applied With Other Offers And Discounts - Some Case/Quantities May Not Be Available On Limited Edition Items</div> <div> All Wines Will Be Shipped On The First Friday Of Each Month</div> <div> Shipping Is Limited In Some States - Please Inquire.</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,Address1,City State Zip,Phone,Pick Up?,Send To Name,Send To Address,Send To City State Zip,Send To Phone Number,Package A B C,# of Mos,Wine Preference,Type Of CC,Name On CC,CC #,Exp Date,Gift Card,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank You For Joining Cork Poppers Wine Of The Month Club, A Confirmation Of Your Order Will Be Sent To You In Approximately 48 Hours."><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">E-mail Must Provide:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address :<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City, State & Zip Code:<br> <input type="text" name="City State Zip" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Pick Up Your Wines? Or Send To -:<br> <input type="text" name="Pick Up?" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Send To: Name:<br> <input type="text" name="Send To Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Send To: Address:<br> <input type="text" name="Send To Address" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Send To: City, State & Zip:<br> <input type="text" name="Send To City State Zip" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Send To: Phone Number:<br> <input type="text" name="Send To Phone Number" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Chose Package A, B, C:<br> <input type="text" name="Package A B C" size="10" maxlength="10"></td> </tr> <tr> <td align="left">For How Many Months:<br> <input type="text" name="# of Mos" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Wine Preference? Red, White, Other, None::<br> <input type="text" name="Wine Preference" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Type Of Credit Card:<br> <input type="text" name="Type Of CC" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Name On Credit Card:<br> <input type="text" name="Name On CC" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Credit Card Number:<br> <input type="text" name="CC #" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Expiration Date:<br> <input type="text" name="Exp Date" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Write Here For A Gift Card If Needed:<br> <textarea name="Gift Card" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="left">Additional Comments:<br> <input type="text" name="Comments" size="30" maxlength="100"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> <bR> </td> </tr></table></body>