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<title>The Daily Item, Sunbury, PA--Form - Subscription</title>
  <link>http://www.dailyitem.com</link>
<description></description>
<language>en-us</language>
<copyright>Copyright CNHI All Rights Reserved.</copyright>

<ttl>5</ttl>

<item>
<pubdate>Thu, 03 Apr 2008 15:47:00 +0000</pubdate>
 <guid>http://www.dailyitem.com/form_subscription/local_story_094154553.html</guid>
 <title>Subscription Form</title>
  <link>http://www.dailyitem.com/form_subscription/local_story_094154553.html</link>
  <description>		<div style="width:400px;">
	
	<p>If you are interested in subscribing to The Daily Item or if you are currently a Daily Item subscriber who is 
	looking to renew your subscription, please fill in the information below. If neccessary, we will contact you 
	in regards to your request.</p>
	
	<h3>How to Reach Us:</h3>
	<p>Circulation Department
	Phone: (570) 286-5755
	Toll-Free: (800) 792-2303
	Hours: 8AM - 5PM Monday - Friday  and amp; 7AM - 11AM Saturday - Sunday
	E-mail us at <a href="mailto:circulation@dailyitem.com?subject=Subscription%20Request">circulation@dailyitem.com</a></p>
	
	<h2>Subscriber Form</h2>
	<form id="form" method="post" action="http://community.cnhi.com/formmail2.php">
		Fullname: *
		<input type="text" name="Name" id="Name" class="textfield" value="">
		
		Email: *
		<input type="text" name="Email" class="textfield" value="">
		
		Phone (xxx-xxx-xxxx): *
		<input name="Phone" id="Phone" class="textfield" size="12" maxlength="15">
		
		Current Status
		<span><input type="radio" name="Current-Status" value="New Suscription"> I am looking to purchase a new subscription.</span>
		<span><input type="radio" name="Current-Status" value="Renew Subscription"> I am looking to renew my current subscription.</span>
		
		<h3>Delivery Address</h3>
		Street Address: *
		<input type="text" name="Delivery-Street-Address" id="Delivery-Street-Address" class="textfield" value="">
		
		City: *
		<input type="text" name="Delivery-City" id="Delivery-City" class="textfield" value="">
		
		State: *
		<select name="Delivery-State" id="Delivery-State" class="textfield">
			<option value="PA, US">Pennsylvania</option>
			<option value="AL, US">Alabama</option>
			<option value="AK, US">Alaska</option>
			<option value="AZ, US">Arizona</option>
			<option value="AR, US">Arkansas</option>
			<option value="CA, US">California</option>
			<option value="CO, US">Colorado</option>
			<option value="CT, US">Connecticut</option>
			<option value="DE, US">Delaware</option>
			<option value="DC, US">District of Columbia</option>
			<option value="FL, US">Florida</option>
			<option value="GA, US">Georgia</option>
			<option value="HI, US">Hawaii</option>
			<option value="ID, US">Idaho</option>
			<option value="IL, US">Illinois</option>
			<option value="IN, US">Indiana</option>
			<option value="IA, US">Iowa</option>
			<option value="KS, US">Kansas</option>
			<option value="KY, US">Kentucky</option>
			<option value="LA, US">Louisiana</option>
			<option value="ME, US">Maine</option>
			<option value="MD, US">Maryland</option>
			<option value="MA, US">Massachusetts</option>
			<option value="MI, US">Michigan</option>
			<option value="MN, US">Minnesota</option>
			<option value="MS, US">Mississippi</option>
			<option value="MO, US">Missouri</option>
			<option value="MT, US">Montana</option>
			<option value="NE, US">Nebraska</option>
			<option value="NV, US">Nevada</option>
			<option value="NH, US">New Hampshire</option>
			<option value="NJ, US">New Jersey</option>
			<option value="NM, US">New Mexico</option>
			<option value="NY, US">New York</option>
			<option value="NC, US">North Carolina</option>
			<option value="ND, US">North Dakota</option>
			<option value="OH, US">Ohio</option>
			<option value="OK, US">Oklahoma</option>
			<option value="OR, US">Oregon</option>
			<option value="RI, US">Rhode Island</option>
			<option value="SC, US">South Carolina</option>
			<option value="SD, US">South Dakota</option>
			<option value="TN, US">Tennessee</option>
			<option value="TX, US">Texas</option>
			<option value="UT, US">Utah</option>
			<option value="VT, US">Vermont</option>
			<option value="VA, US">Virginia</option>
			<option value="WA, US">Washington</option>
			<option value="WV, US">West Virginia</option>
			<option value="WI, US">Wisconsin</option>
			<option value="WY, US">Wyoming</option>
		</select>
		
		Zip Code: *
		<input type="text" name="Delivery-Zip" id="Delivery-Zip" class="textfield" style="width:80px;" value="">

		<h3>Mailing Address (If different from above)</h3>
		Street Address:
		<input type="text" name="Mailing-Street-Address" id="Mailing-Street-Address" class="textfield" value="">
		
		City: 
		<input type="text" name="Mailing-City" id="Mailing-City" class="textfield" value="">
		
		State: 
		<select name="Mailing-State" id="Mailing-State" class="textfield">
			<option value=""></option>
			<option value="AL, US">Alabama</option>
			<option value="AK, US">Alaska</option>
			<option value="AZ, US">Arizona</option>
			<option value="AR, US">Arkansas</option>
			<option value="CA, US">California</option>
			<option value="CO, US">Colorado</option>
			<option value="CT, US">Connecticut</option>
			<option value="DE, US">Delaware</option>
			<option value="DC, US">District of Columbia</option>
			<option value="FL, US">Florida</option>
			<option value="GA, US">Georgia</option>
			<option value="HI, US">Hawaii</option>
			<option value="ID, US">Idaho</option>
			<option value="IL, US">Illinois</option>
			<option value="IN, US">Indiana</option>
			<option value="IA, US">Iowa</option>
			<option value="KS, US">Kansas</option>
			<option value="KY, US">Kentucky</option>
			<option value="LA, US">Louisiana</option>
			<option value="ME, US">Maine</option>
			<option value="MD, US">Maryland</option>
			<option value="MA, US">Massachusetts</option>
			<option value="MI, US">Michigan</option>
			<option value="MN, US">Minnesota</option>
			<option value="MS, US">Mississippi</option>
			<option value="MO, US">Missouri</option>
			<option value="MT, US">Montana</option>
			<option value="NE, US">Nebraska</option>
			<option value="NV, US">Nevada</option>
			<option value="NH, US">New Hampshire</option>
			<option value="NJ, US">New Jersey</option>
			<option value="NM, US">New Mexico</option>
			<option value="NY, US">New York</option>
			<option value="NC, US">North Carolina</option>
			<option value="ND, US">North Dakota</option>
			<option value="OH, US">Ohio</option>
			<option value="OK, US">Oklahoma</option>
			<option value="OR, US">Oregon</option>
			<option value="PA, US">Pennsylvania</option>
			<option value="RI, US">Rhode Island</option>
			<option value="SC, US">South Carolina</option>
			<option value="SD, US">South Dakota</option>
			<option value="TN, US">Tennessee</option>
			<option value="TX, US">Texas</option>
			<option value="UT, US">Utah</option>
			<option value="VT, US">Vermont</option>
			<option value="VA, US">Virginia</option>
			<option value="WA, US">Washington</option>
			<option value="WV, US">West Virginia</option>
			<option value="WI, US">Wisconsin</option>
			<option value="WY, US">Wyoming</option>
		</select>
		
		Zip Code: 
		<input type="text" name="Mailing-Zip" id="Mailing-Zip" class="textfield" style="width:80px;" value="">
		
		<h3>Package Details</h3>
		The Daily Item Packages: *
		<span><input type="radio" name="Daily-Item-Package" value="Annual Suscription"> Annual Subscription - $172 for 52 weeks</span>
		<span><input type="radio" name="Daily-Item-Package" value="Quarterly Subscription"> Quarterly Subscription - $45.50 for 13 weeks</span>
		<span><input type="radio" name="Daily-Item-Package" value="Introductory Annual Suscription"> First Time Subscribers Introductory offer Annual Subscription - $91 for 52 weeks</span>
		<span><input type="radio" name="Daily-Item-Package" value="Introductory Quarterly Subscription"> First Time Subscribers Introductory offer Quarterly Subscription - $39 for 13 weeks</span>
		<span><input type="radio" name="Daily-Item-Package" value="Mailbox Subscription - PA"> Mailbox Subscription (PA Residents) - $6 per week</span>
		<span><input type="radio" name="Daily-Item-Package" value="Mailbox Subscription - Out of State"> Mailbox Subscription (Out-of-state Residents) - $7 per week</span>
		<span><input type="radio" name="Daily-Item-Package" value="None"> None</span>
		
		The Danville News Packages: *
		<span><input type="radio" name="Danville-News-Package" value="Annual Suscription"> 2-Year Subscription - $32.50 for 2 years</span>
		<span><input type="radio" name="Danville-News-Package" value="Mailbox Subscription - PA"> Mailbox Subscription (PA Residents) - $3.50 per weeks</span>
		<span><input type="radio" name="Danville-News-Package" value="Mailbox Subscription - Out of State"> Mailbox Subscription (Out-of-state Residents) - $4 per week</span>
		<span><input type="radio" name="Danville-News-Package" value="None"> None</span>

		
		Are you interested in the EZ-Pay Program? *
		<span style="padding-left:20px;">Yes </span><input type="radio" name="EZ-Pay-Program" value="Yes">
		<span>No </span><input type="radio" name="EZ-Pay-Program" value="No">

		
		<p>* Denotes A Required Field</p>
		
		
		<input type="submit" name="submit" value="Submit">
		<input type="hidden" name="redirect" value="http://static.dailyitem.com/forms/thanks/thanks-subscriber.htm">
		<input type="hidden" name="recipient" value="circulation@dailyitem.com,website@dailyitem.com">
		<input type="hidden" name="subject" value="New Subscriber from The DailyItem.com">
		<input type="hidden" name="require" value="Name,  Email, Phone, Delivery-Street-Address, Delivery-City, Delivery-State, Delivery-Zip, Daily-Item-Package, Danville-News-Package, EZ-Pay-Program">
	</form>

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