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<table border="0" width="445px" cellspacing="0" cellpadding="0"> <tr><td colspan="5"><img src="img/spacer.gif" width="1px" height="20px" border="0"></td></tr> <tr><td width="15"><img src="img/spacer.gif" width="15px" height="1px" border="0"></td> <td valign=top align="left"><div class="redtitle">Contact Us</div> <p class="main"> <FORM METHOD="POST" ACTION="http://www.cereality.com/email_contact.php"> <table cellpadding="0" cellspacing="0" border="0"><tr><td> <span class="main">Name</span><td><input type="text" name="Name" size="20"> </td></tr> <tr><td> <span class="main">Email</span><td><input type="text" name="email" size="20"> </td></tr> <tr><td> <span class="main">City, State</span><td><input name="City_State" type="text" id="City_State" size="20"> </td></tr></table> <BR> <span class="main">I'm hungry for more...<br>I want a Cereality at my: <br>(check as many as apply)</span> <BR> <table cellpadding="0" cellspacing="0" border="0"><tr><td> <input type="checkbox" value="" name="I want Cereality at work"></td><td><span class="main">Place of work:</span></td><td><input name="Work_Name" type="text" id="Work_Name" size="15"></td></tr> <tr><td> <input type="checkbox" name="I want Cereality at school"></td><td><span class="main">School:</span></td><td><input name="School_Name" type="text" id="School_Name" size="15"></td></tr> <tr><td> <input type="checkbox" name="I want Cereality at airport"></td><td><span class="main">Airport:</span></td><td><input name="Airport_Name" type="text" id="Airport_Name" size="15"></td></tr> <tr><td> <input type="checkbox" name="I want Cereality at other"></td><td><span class="main">Other:</span></td><td><input name="Other_Name" type="text" id="Other_Name" size="15"></td></tr></table><BR> <table cellpadding="0" cellspacing="0" border="0"><tr><td> <input type="checkbox" name="Add_to_email_list"></td><td><span class="main">Add me to your email list for updates on store openings and Cereality info.</span></td> </tr></table> <BR> <table cellpadding="0" cellspacing="0" border="0"><tr><td><span class="main"> My favorite cereal or cereal combination is:</span></td><td> <input type="text" name="my_favorite_cereal_combo" size="20"></td></tr></table> <br> <table cellpadding="0" cellspacing="0" border="0"><tr><td> <input type="checkbox" name="I_eat_breakfast_only"></td><td><span class="main">I eat cereal for breakfast only</span></td></tr> <tr><td> <input type="checkbox" name="I_have_cereal_for_lunch_and_dinner"></td><td><span class="main">I have cereal for lunch or dinner sometimes</span></td></tr><tr><td> <input type="checkbox" name="I_snack_on_ceral_at_different_times"></td><td><span class="main">I snack on cereal at different times of day</span></td></tr> </table><br> <span class="main"> Other comments/feedback:</span><br> <textarea rows="5" name="Other_comments_feedback" cols="30"> </textarea> <BR><BR> <input type="submit" value="Submit"> </form> </p> </td><td width="10"><img src="img/spacer.gif" width="10px" height="1px" border="0"></td> <td valign=top><img src="img/contact_main.jpg" width="138" height="323" border="0"></td> <td width="15"><img src="img/spacer.gif" width="15px" height="1px" border="0"></td> </tr> <tr> <td width="15"><img src="img/spacer.gif" width="15px" height="1px" border="0"></td> <td valign=top align="left"> <img src="img/spacer.gif" width="15px" height="15px" border="0"><BR> </td><td width="10px"><img src="img/spacer.gif" width="10px" height="1px" border="0"></td> <td valign=top> </td> <td width="15"><img src="img/spacer.gif" width="15px" height="1px" border="0"></td></tr> </table>
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Cereality is a registered trademark of Kahala Corp and/or its subsidaries.
