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<title>
Pumpernickels Bagelry Office Caterers; 
specializing in office catering, tour group box lunches, and party platters since 1991.
</title>
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<form method="post" action="FormMail.pl">    
  <table 0 width="520" align="CENTER" >
    <tr valign="top"> 
        <td align=CENTER colspan="2"><b><font face="Verdana, Arial, Helvetica, sans-serif"><font size="4" color=red>Please 
          input all of the following information:</font></b>
         </td>
      </tr>

<!-- Name -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Name: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
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        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input type="TEXT" name="realname" size="20" maxlength="30">
            </font></b>
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        </td>
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<!-- E-mail -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Email address: </font></b>
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        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="email" type="TEXT" size="20">
            </font></b>
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<!-- Company -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Company: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
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        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="Company" type="TEXT" size="20" maxlength="40">
            </font></b>
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        </td>
      </tr>

<!-- Address -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Address: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
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        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="Address" type="TEXT" size="20" maxlength="40">
            </font></b>
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        </td>
      </tr>

<!-- City -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">City: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
</div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="City" type="TEXT" size="20" maxlength="30"
             option value="Washington">
            </font></b>
</div>
        </td>
      </tr>

<!-- State or province -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">State/Province: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
</div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
                <select name="State">
                  <option value="AK">AK</option>
                  <option value="AL">AL</option>
                  <option value="AR">AR</option>
                  <option value="AZ">AZ</option>
                  <option value="CA">CA</option>
                  <option value="CO">CO</option>
                  <option value="CT">CT</option>
                  <option value="DC" selected>DC</option>
                  <option value="DE">DE</option>
                  <option value="FL">FL</option>
                  <option value="GA">GA</option>
                  <option value="HI">HI</option>
                  <option value="IA">IA</option>
                  <option value="ID">ID</option>
                  <option value="IL">IL</option>
                  <option value="IN">IN</option>
                  <option value="KS">KS</option>
                  <option value="KY">KY</option>
                  <option value="LA">LA</option>
                  <option value="MA">MA</option>
                  <option value="MD">MD</option>
                  <option value="ME">ME</option>
                  <option value="MI">MI</option>
                  <option value="MN">MN</option>
                  <option value="MO">MO</option>
                  <option value="MS">MS</option>
                  <option value="MT">MT</option>
                  <option value="NB">NB</option>
                  <option value="NC">NC</option>
                  <option value="ND">ND</option>
                  <option value="NH">NH</option>
                  <option value="NJ">NJ</option>
                  <option value="NM">NM</option>
                  <option value="NV">NV</option>
                  <option value="NY">NY</option>
                  <option value="OH">OH</option>
                  <option value="OK">OK</option>
                  <option value="OR">OR</option>
                  <option value="PA">PA</option>
                  <option value="PR">PR</option>
                  <option value="RI">RI</option>
                  <option value="SC">SC</option>
                  <option value="SD">SD</option>
                  <option value="TN">TN</option>
                  <option value="TX">TX</option>
                  <option value="UT">UT</option>
                  <option value="VA">VA</option>
                  <option value="VT">VT</option>
                  <option value="WA">WA</option>
                  <option value="WI">WI</option>
                  <option value="WV">WV</option>
                  <option value="WY">WY</option>
                </select>

            </font></b> 
          </div>
        </td>
      </tr>

<!-- Zip -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Zip 
            Code: </font></b>
</div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left"><b><font face="Verdana, Arial, Helvetica, sans-serif"><font color="#FFFFFF"> 
            <input name="Zip Code" type="text" size="10" maxlength="10" option value="20006">
            </font></font></b></div>
        </td>
      </tr>

<!-- Country -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Country: 
            </font><font face="Verdana, Arial, Helvetica, sans-serif"> </font></b>
</div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left">
            <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="Country" type="TEXT" size="20" maxlength="30"
             option value="United States">
            </font></b>
</div>
        </td>
      </tr>

<!-- Telephone -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Telephone: 
            </font></b> 
          </div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left"><b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="Area Code" type="text" size="3" 
             maxlength="3" option value="202">
            -&nbsp; 
            <input name="Phone Number" type="text" size="8" maxlength="8">
            </font></b></div>
        </td>
      </tr>

<!-- Catering -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Does Your Firm Do Any Office Catering (Y/N)?  
            </font></b> 
          </div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left"><b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input name="Office Catering" type="text" size="1" 
             maxlength="1">
            </font></b></div>
        </td>
      </tr>

<!-- Comments -->
      <tr valign="top"> 
        <td align=CENTER width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" size="2">Comments?  
            </font></b> 
          </div>
        </td>
        <td align=CENTER width="57%"> 
          <div align="left"><b><font face="Verdana, Arial, Helvetica, sans-serif"> 
       <textarea name="Comments" cols=40 rows=3></textarea>                   </font></b></div>
        </td>
      </tr>



<!-- select options -->
      <tr valign="top"> 
        <td width="43%"> 
          <div align="right">
            <b><font face="Verdana, Arial, Helvetica, sans-serif" 
            size="2">Select Options:</font></b>
</div>
	<INPUT TYPE="hidden" NAME="recipient" VALUE="brigid68@juno.com"> 
	<INPUT TYPE="hidden" NAME="subject" 
  VALUE="New Subscriber has been added to your mailing list">
	<INPUT TYPE="hidden" NAME="title"
 VALUE="Thanks for your subscription">
        <INPUT TYPE="hidden" NAME="redirect" VALUE="cookie.html">
   <!--	<INPUT TYPE="hidden" NAME="redirect" VALUE="thankyou.html">-->
	<INPUT TYPE="hidden" NAME="required" VALUE="email, Office Catering">
  	<INPUT TYPE="hidden" NAME="return_link_url" VALUE="home.html">
	<INPUT TYPE="hidden" NAME="return_link_title" VALUE="Click Here To Return to Pumpernickels Bagelry Home Page">
	</td>
        <td align=CENTER width="57%"> 
          <p align="left"><b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            <input type="SUBMIT" Name="button" value="Subscribe">
            <input type="reset" name="Application Cancelled"
            value="Reset">
            </font></b> <b><font face="Verdana, Arial, Helvetica, sans-serif"> 
            </font></b> 
          <p>&nbsp; 
        </td>
      </tr>
    </table>
  </form>

  
<table border="0" width="100%" cellspacing="0" cellpadding="0">
  <tr> 
    <td colspan="5"> 
      <div align="CENTER">
        <font face="Verdana, Arial, Helvetica, sans-serif" size="1">Return to 
        <a href=home.html>
        pumpdeli.com </a></font> 
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