Refer a Friend to our Home Grocery Service<meta name="keywords" content=""> <meta name="description" content=""> <link rel="stylesheet" href="css/jd.gallery.css" type="text/css" media="screen" charset="utf-8"> <script src="scripts/mootools-1.2.1-core-yc.js" type="text/javascript"></script><script src="scripts/mootools-1.2-more.js" type="text/javascript"></script><script src="scripts/jd.gallery.js" type="text/javascript"></script><script src="scripts/jd.gallery.transitions.js" type="text/javascript"></script><link rel="stylesheet" type="text/css" href="style-web.css"> <script language="JavaScript">  </script><body> <div id="top"> <div id="topcentered"> <div id="logo"> <a href="/"><img src="images/logo.jpg"></a> </div>  <div id="menu"> <ul> <li><a href="/" class="small">Home</a></li> <li><a href="testimonials.html" class="large">Testimonials</a></li> <li><a href="about.html" class="med">About Us</a></li> <li> <a href="howitworks.html" class="large">How It Works</a> </li> <li> <a href="products.html" class="med">Products</a> </li> <li>Promotions </li> <li> <a href="contact.html" class="med">Contact Us</a> </li> </ul> </div>  </div>  </div>  <div id="menu2"> <div id="menu2-text"> <a href="promo-freezer.html">Free Freezer</a>? <a href="promo-refer-form.php" class="current">Refer a Friend Rewards Program</a> <a href="promo-groceries.html">Win Groceries for a Year</a> <a href="promo-holiday.html">Holiday Specials</a> </div> </div>  <div id="wrapper"> <div id="content"> <div id="content-wide"> <div class="content-wide-text"> <form id="form" method="post" action="promo-refer-mailer.php" enctype="multipart/form-data" onsubmit="return Blank_TextField_Validator()"> <h1>Refer a Friend Rewards Program</h1> Please fill in the following form and press "Submit."? Note: fields in <span class="green">green</span> are required in order to submit this form - at least your information and the information of your first referral customer. You may refer up to three people total, but please be sure to fill in <b>all</b> the fields for every person you refer. <br><br> <table width="650">  <tr> <td valign="top" colspan="2"> <span class="greenbold">Your Information</span> <br><br> </td> </tr> <tr> <td width="48%" valign="top" align="left"> <span class="green">First name:???? </span> <input type="text" name="First_Name" tabindex="1" required size="25"> <br><br> <span class="green">City or Town:</span>?? <input type="text" name="City_or_Town" tabindex="3" required size="25"> <br> </td> <td width="55%" valign="top" align="right"> <span class="green">Last name:</span>?????? <input type="text" name="Last_Name" tabindex="2" required size="25"> <br><br> <span class="green">Phone Number:</span>?? <input type="text" name="Phone_Number" tabindex="4" required size="25"> <br><br><br> </td> </tr>  <tr> <td valign="top" colspan="2"> <b>Referral # 1</b> <br><br> </td> </tr> <tr> <td width="48%" valign="top" align="left"> <span class="green">First name:</span>???? <input type="text" name="Referral1_First_Name" tabindex="5" required size="25"> <br><br> <span class="green">City or Town:</span>?? <input type="text" name="Referral1_City_or_Town" tabindex="7" required size="25"> <br><br> </td> <td width="55%" valign="top" align="right"> <span class="green">Last name:</span>?? <input type="text" name="Referral1_Last_Name" tabindex="6" required size="25"> <br><br> <span class="green">Phone Number:</span>?? <input type="text" name="Referral1_Phone_Number" tabindex="8" required size="25"> </td> </tr> <tr> <td colspan="2"> <center> <input type="submit" class="submit" name="submit" value="Submit"> ? ? ? <input type="reset" class="submit" name="Reset" value="Reset"> <br><br> </center> </td> </tr>  <tr> <td valign="top" colspan="2"> <b>Referral # 2</b> <br><br> </td> </tr> <tr> <td width="48%" valign="top" align="left"> First name:???? <input type="text" name="Referral2_First_Name" tabindex="9" size="25"> <br><br> City or Town:?? <input type="text" name="Referral2_City_or_Town" tabindex="11" size="25"> <br> </td> <td width="55%" valign="top" align="right"> Last name:?? <input type="text" name="Referral2_Last_Name" tabindex="10" size="25"> <br><br> Phone Number:?? <input type="text" name="Referral2_Phone_Number" tabindex="12" size="25"> <br><br> </td> </tr> <tr> <td colspan="2"> <center> <input type="submit" class="submit" name="submit" value="Submit"> ? ? ? <input type="reset" class="submit" name="Reset" value="Reset"> <br><br> </center> </td> </tr>  <tr> <td valign="top" colspan="2"> <b>Referral # 3</b> <br><br> </td> </tr> <tr> <td width="48%" valign="top" align="left"> First name:???? <input type="text" name="Referral3_First_Name" tabindex="13" size="25"> <br><br> City or Town:?? <input type="text" name="Referral3_City_or_Town" tabindex="15" size="25"> <br><br> </td> <td width="55%" valign="top" align="right"> Last name:?? <input type="text" name="Referral3_Last_Name" tabindex="14" size="25"> <br><br> Phone Number:?? <input type="text" name="Referral3_Phone_Number" tabindex="16" size="25"> <br><br> </td> </tr> <tr> <td colspan="2"> <center> <input type="submit" class="submit" name="submit" value="Submit"> ? ? ? <input type="reset" class="submit" name="Reset" value="Reset"> <br><br> </center> </td> </tr>  </table> <input type="hidden" name="Sender_E_mail" value="referrals@northernprovincial.com"> <input type="hidden" name="config" value="0"> <br><br> </form> <div class="clear"></div> </div>  </div>  <div class="clear"> </div> </div>  </div>  <div id="footer"> <div id="footer-links"> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">Home</a></li> <li><a href="">Home Page</a></li> </ul> </div> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">About Us</a></li> <li><a href="about-testimonials.html">Testimonials</a></li> <li>Mission & Values</li> <li>Responsibility</li>   </ul> </div> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">How It Works</a></li> <li><a href="how-whatwedo.html">What We Do</a></li> <li><a href="">Advantages</a></li> <li><a href="">Delivery</a></li> <li><a href="how-guarantee.html">Guarantee</a></li> <li><a href="">FAQs</a></li> </ul> </div> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">Products</a></li> <li><a href="">Products</a></li> </ul> </div> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">Promotions</a></li> <li><a href="promo-refer-form.php">Refer a Friend</a></li>  </ul> </div> <div class="footer-section"> <ul> <li class="footer-headline"><a href="#" class="footer-headline">Contact Us</a></li> <li><a href="contact.html">Contact Us</a></li> </ul> </div> <div class="clear"></div> </div>  </div>  </body>