<%
'-----------------------------------------------------------
'-----
'-----         Forms To Go v2.1.2   by   Bebosoft
'-----
'-----             http://www.bebosoft.com/
'-----
'-----------------------------------------------------------
'-----
'-----                UNREGISTERED COPY
'-----
'-----     Forms To Go is shareware. When you register it
'-----     you'll remove all registration reminders and
'-----     software restrictions. Thanks for your support
'-----
'-----------------------------------------------------------


Dim objCDO
 Set Mail = Server.CreateObject("Persits.MailSender")
  Mail.Host = "207.93.101.20"

  'Mail.Username = "webemail"
  'Mail.Password = "transponder"

Firstname = request.form("Firstname")
Lastname = request.form("Lastname")
Organization = request.form("Organization")
Title = request.form("Title")
Address = request.form("Address")
Address2 = request.form("Address2")
City = request.form("City")
State = request.form("State")
Zipcode = request.form("Zipcode")
Phone = request.form("Phone")
Email = request.form("Email")
Comment = request.form("Comment")
Submit = request.form("Submit")


if (validationfailed = true) then

' Redirect user to FAIL page

 Response.Redirect "error.html"


Else

' Email Body

body_mail_form = "Firstname: " & Firstname & "" & vbCrLf _
 & "Lastname: " & Lastname & "" & vbCrLf _
 & "Organization: " & Organization & "" & vbCrLf _
 & "Title: " & Title & "" & vbCrLf _
 & "Address: " & Address & "" & vbCrLf _
 & "Address2: " & Address2 & "" & vbCrLf _
 & "City: " & City & "" & vbCrLf _
 & "State: " & State & "" & vbCrLf _
 & "Zipcode: " & Zipcode & "" & vbCrLf _
 & "Phone: " & Phone & "" & vbCrLf _
 & "Email: " & Email & "" & vbCrLf _
 & "Comment: " & Comment & "" & vbCrLf _
 & "Submit: " & Submit & "" & vbCrLf _
 & "" & vbCrLf _
 & ""


' Send the email to the form owner

objCDO.To = " <debbi.cunnington@corecubed.com>"
objCDO.From = Email
objCDO.Subject = "Merit Health Inquiry"
objCDO.Body = body_mail_form
objCDO.Send

' Dump fields to text file

' Redirect user to OK page

 Response.Redirect "success.html"

End If
' End of ASP script
%>