<% @ Language=VBScript %> <% Option Explicit response.buffer=true%> <% dim num num = Request.ServerVariables("SCRIPT_NAME") application.lock if isEmpty(application(num)) Then application(num)=0 END IF application(num)=application(num)+1 application.unlock %> <% dim newmail, strfeed, ipadd, brow, now, msgbody, date, strprefix, strrequiredfname, strrequiredlname, strphone, strstreet, strcity, strselect2, strpostal, strcountry, strrequiredemail, strrequiredemail2, strrequiredcomment brow = Request.servervariables("HTTP_USER_AGENT") ipadd= Request.ServerVariables("REMOTE_ADDR") date = time strprefix=Trim(Request.Form("prefix")) strrequiredfname=Trim(Request.Form("required-fname")) strrequiredlname=Trim(Request.Form("required-lname")) strphone=Trim(Request.Form("phone")) strstreet=Trim(Request.Form("street")) strcity=Trim(Request.Form("city")) strselect2=Trim(Request.Form("select2")) strpostal=Trim(Request.Form("postal")) strcountry=Trim(Request.Form("country")) strrequiredemail=Trim(Request.Form("required-email")) strrequiredemail2=Trim(Request.Form("required-email2")) strrequiredcomment=Trim(Request.Form("required-comment")) num = application(num) msgbody = ("Prefix: " & strprefix & vbcrlf & "FName: " & strrequiredfname & vbcrlf & "LName: " & strrequiredlname & vbcrlf & "Phone: " & strphone & vbcrlf & "Street: " & strstreet & vbcrlf & "City: " & strcity & vbcrlf & "CMethod: " & strselect2 & vbcrlf & "Postal: " & strpostal & vbcrlf & "Country: " & strcountry & vbcrlf & "Email: " & strrequiredemail & vbcrlf & "Email2: " & strrequiredemail2 & vbcrlf & "Comments: " & strrequiredcomment & vbcrlf & "PC info:" & "IP:" & ipadd & "Browser: " & brow & "Time:" & date & "Hits:" & num &"times!") if (strrequiredfname <> "" and strrequiredemail <> "")then Set Newmail = Server.CreateObject ("cdonts.newmail") Newmail.From = strrequiredemail Newmail.To = "suneet@datawind.com" Newmail.Subject = "RequestForm:" & strrequiredfname Newmail.Body = msgbody Newmail.Send Set Newmail = Nothing response.redirect "Thanks.htm" End if %> Welcome to PocketSurfer3 : Request_form
 
 
   
   
   
 
 
Fields marked (*) are mandatory  
Prefix:
*First/Middle name:
*Last name:
Phone:
 
Address:
City:
Preferred Contact Method:
Postal code:
Country:
 
*Email address:
*Re-enter email address:
 
*Question / Request for Information :
 
 
 
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