<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> <% ' *** Send Form Values From Same Page to Webmaster - CDO NewMail ' *** UltraSuite Server Behavior - CDOMail_111 - version 1.0 ' *** Created by Jag S. Sidhu - www.ultrasuite.com Dim usxCDO Set usxCDO = Server.CreateObject("CDONTS.NewMail") usxCDO.From = Request.Form("EmailAddress") usxCDO.To = "mhamlett@nc.rr.com;tony@bbph.com;linda@bbph.com;kellie@bbph.com" usxCDO.Subject = "Residential/Commercial Service Request" usxCDO.Body = Chr(13) & Chr(10) &_ "Commercial Request: " & cStr(Request("Commercial")) & Chr(13) & Chr(10) &_ "Residential Request: " & cStr(Request("Residential")) & Chr(13) & Chr(10) &_ "Email Address: " & cStr(Request("EmailAddress")) & Chr(13) & Chr(10) &_ "Customer Name: " & cStr(Request("Name")) & Chr(13) & Chr(10) &_ "Company Name: " & cStr(Request("CompanyName")) & Chr(13) & Chr(10) &_ "Address Line 1: " & cStr(Request("Address1")) & Chr(13) & Chr(10) &_ "Address Line 2: " & cStr(Request("Address2")) & Chr(13) & Chr(10) &_ "City/State/Zip: " & cStr(Request("CityStZip")) & Chr(13) & Chr(10) &_ "Telephone Number: " & cStr(Request("TelephoneNumber")) & Chr(13) & Chr(10) &_ "Cell Phone Number: " & cStr(Request("CellNumber")) & Chr(13) & Chr(10) &_ "Fax Number: " & cStr(Request("FaxNumber")) & Chr(13) & Chr(10) &_ "Service Request: " & cStr(Request("Comments")) & Chr(13) & Chr(10) &_ "Done work for you before: " & cStr(Request("DoneWorkBefore")) & Chr(13) & Chr(10) &_ "Payment Method: " & cStr(Request("PaymentMethod")) & Chr(13) & Chr(10) &_ "Property Address 1: " & cStr(Request("Propertyadd1")) & Chr(13) & Chr(10) &_ "Property Address 2: " & cStr(Request("Propertyadd2")) & Chr(13) & Chr(10) &_ "Property City/State/Zip: " & cStr(Request("Propertycitystzip")) If (cStr(Request("Submit")) <> "") Then usxCDO.Send Set usxCDO = Nothing Response.Redirect "thankyou.asp" End If %> Service Request
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Commercial/Residential Service Request

Complete the following form and Submit it to us.  Your comments are welcome. 
If you need an immediate response, call us at 919-220-2554.  
We may also be contacted via the "Contact Us" page

Commericial Residential (check one)

Your Name

Company Name
Address 1
Address 2
City,State,Zip 
Telephone Number
Cell Number
Fax Number 
Your Email Address [required]
Service Request Details  
Method of Payment
Have we done work for you before?: Yes
No
Use this area if the information you are requesting is for a property other than that listed above.
Property Address 1 
Property Address 2 
Property City,State,Zip 

If you are having trouble with this form, please email us.

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