Add Your Name to Our Mailing List

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=185 BGCOLOR="#003333" TEXT="#F7F7FF" bgproperties="fixed" background="181d4c00dduajq.jpg"> <bR> <bR> <bR> <div> <IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="9"><B>       </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="17"><B>   </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="17"><B>       </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="9"></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="Law Offices of Mathews Bergen Grier"><B>Home</B></A></div> </td> <td valign="top" colspan=2 height=100 BGCOLOR="#FFFBF0" TEXT="#080000"> <div> <I>Add Your Name to Our Mailing List</I></div> <div> </div> </td> </tr><tr> <td valign="top" height=380 width="100%" colspan=2 BGCOLOR="#FFFBF0" TEXT="#080000"> <div> We may send out information, brochures or news to our clients or the public. There is never an obligation.  But, if you would like to add your name to our mailing list for any reason, please fill-out this form:</div> <bR> <div>  <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="LastName,First Name,Company,Address1,Address2,e-mail,City,State,Zip,Phone,MailingList,[Custom],Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request. You will be placed on our mailing list, for either e-mail or regular (snail mail) information. Thanks again from MATHEWS BERGEN & GRIER"><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A "add to mailing list" form was submitted"><input type="hidden" name="tlx_EmailTo" value="mbglaw@cts.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">First Name:<br> <input type="text" name="First Name" 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">Address2:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">e-mail (Required for our e-mail list):<br> <input type="text" name="e-mail" 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> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="left">Indicate your area of interest. If you wish to be on the e-mail list, indicate that here. If you do not want to receive e-mails from us, tell us that. If you don't receive e-mail, MAKE SURE YOU INDICATE YOU ONLY WANT A REGULAR MAIL RESPONSE:<br> <input type="text" name="[Custom]" size="80" maxlength="500"></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>