<% Response.write("Here") If Request.Form("submit") Then Response.write("Here2") '--- Create an instance of the AspMail object --- set Mailer = Server.CreateObject("SMTPsvg.Mailer") '--- Set all the properties of the email header --- Mailer.FromName = "Club Alsa" Mailer.FromAddress = "info@alsamedspa.com" Mailer.RemoteHost = "mail-fwd" Mailer.AddRecipient "Todd Bennett", "todd_bennett30@hotmail.com" Mailer.Subject = "Club Alsa Information Request" '--- Loop through each item sent from the HTML form --- '--- and put it into variable with carriage returns --- strName = Request.Form("Name") strAddress = Request.Form("Address") strCity = Request.Form("City") strState = Request.Form("State") strZip = Request.Form("Zip") strPhone = Request.Form("Phone") strMobil = Request.Form("Mobil") strLaser = Request.Form("Laser") strFiller = Request.Form("Filler") strBotox = Request.Form("Botox") strConcern = Request.Form("Concern") strMsgInfo = "Name: " & strName & vbCrLf strMsgInfo = strMsgInfo & "Address: " & strAddress & vbCrLf strMsgInfo = strMsgInfo & "City: " & strCity & vbCrLf strMsgInfo = strMsgInfo & "State: " & strState & vbCrLf strMsgInfo = strMsgInfo & "Zip: " & strZip & vbCrLf strMsgInfo = strMsgInfo & "Phone: " & strPhone & vbCrLf strMsgInfo = strMsgInfo & "Mobil: " & strMobil & vbCrLf strMsgInfo = strMsgInfo & "Laser: " & strLaser & vbCrLf strMsgInfo = strMsgInfo & "Filler: " & strFiller & vbCrLf strMsgInfo = strMsgInfo & "Botox: " & strBotox & vbCrLf strMsgInfo = strMsgInfo & "Concern: " & strConcern & vbCrLf '--- Add visual formatting elements to the email --- strMsgHeader = "Form information follows:" & vbCrLf strMsgHeader = strMsgHeader & "*************" & vbCrLf strMsgFooter = "*************" '--- Assemble the header, form data and footer then --- '--- assign them to the body of the AspMail message --- Mailer.BodyText = strMsgHeader & strMsgInfo & strMsgFooter '--- If the message sends, print some useful output --- '--- to the browser or redirect user to success URL --- If Mailer.SendMail Then Set Mailer = Nothing ' Use either these four print statements, or the ' redirect statement below them (commented out) Response.Write "The message was sent!

" Response.Write "The body of the message was:

" Response.Write "
" & strMsgHeader & "
" & strMsgInfo
            Response.Write "
" & strMsgFooter & "
" ' Response.Redirect "http://domain.com/mysuccesspage.html" '--- If the AspMail object did not send the message --- '--- then print any error(s) it found to the browser --- Else Response.Write "An error has occurred. " Response.Write "The error was " & Mailer.Response Set Mailer = Nothing End If End If %>
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Name:
Address:
City: State: Zip:
Phone:
Mobil:
Have you ever had any of the following procedures:
Laser Yes  No
Filler Yes  No
Botox Yes  No
Do you have any concerns about your skin: