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DR. VICKSMAN'S TV VIDEO
5353 E. Evans Ave.
Denver, CO 80222
Phone: (303)757-7881
Fax: (303)757-7896
Email: eeah@evanseastvet.com
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Business Hours
Monday - Friday:

8:00 AM - 6:00 PM
Saturday:

8:00 AM - 12:00 PM
Sunday:

Closed

<%if Request("Submit")<>"Submit" then%>

Thank you for contacting us
Last Name:  
First Name:  
Email:  
Birthday:  Month             Day            
Street Address:  
City:  
State:  
Zip Code:  
Phone Number:   -  - 
Comments:  







<% else 'SAVE DATABASE strConnString = "Provider=Microsoft.Jet.OLEDB.4.0;Data Source=" & Server.MapPath("database\cmer.mdb") Set adoConn = Server.CreateObject("ADODB.Connection") adoConn.ConnectionString = strConnString adoConn.Open set rsDon=server.CreateObject("ADODB.Recordset") set rsMH=server.CreateObject("ADODB.Recordset") sql="Select * from cmerInfo" rsDon.open sql,adoConn,1,3 rsDon.Addnew rsDon("fname")=request("fname") rsDon("lname")=request("lname") rsDon("email")=request("email") rsDon("dob")=request("DATE1") &"/"& request("DATE2") rsDon("street")=request("address") rsDon("city")=request("city") rsDon("state")=request("state") rsDon("zip")=request("zip") rsDon("hphone")=request("t_Selection10") &" "& request("t_Selection10a") &" "& request("t_Selection10b") rsDon("comments")=request("comments") rsDon("newsletter")=request("newsletter") rsDon.update ' SEND MAIL Dim txtSubject,txtfName,txtlname,txtAddress,txtCity,txtState,txtPhone,txtEmail,txtComments,newsletter txtSubject="Customer Information" txtfName =Trim(Request("fname")) txtlName =Trim(Request("lname")) txtdob =Trim(request("DATE1") &"/"& request("DATE2")) txtAddress =Trim(Request("address")) txtCity =Trim(Request("city")) txtState =Trim(Request("state")) txtzip =Trim(Request("zip")) txtPhone =request("t_Selection10") &" "& request("t_Selection10a") &" "& request("t_Selection10b") txtEmail =Trim(Request("email")) txtComments=Trim(Request("comments")) txtnewsletter =Trim(request("newsletter")) strBody= "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "" strBody=strBody & "
Subject: " & txtSubject & "
First name: " & txtfName & "
Last name: " & txtlName & "
dob: " & txtdob & "
Address: " & txtAddress & "
City: " & txtCity & "
State or Province: " & txtState & "
Zipcodde: " & txtzip & "
Telphone: " & txtPhone & "
Email Address: " & txtEmail & "
Comments:
" strBody=strBody & "
" & txtComments & "
newsletter: " & txtnewsletter & "
" Dim objCDOSYSMail,objCDOSYSCon,sSmtp_mail,sContactTo Set objCDOSYSMail = Server.CreateObject("CDO.Message") Dim sFrom, sTo, sBCC, sCC sFrom = "eeah@evanseastvet.com" 'Request("email") sTo = "eeah@evanseastvet.com" objCDOSYSMail.From= sFrom objCDOSYSMail.To = sTo objCDOSYSMail.Subject = Subject objCDOSYSMail.HTMLBody = strBody objCDOSYSMail.Send If IsObject(objCDOSYSMail) Then Response.Write("") Response.Write("") Else Response.Write("Your e-mail hasn't sent successfully. Please try again.") End If Set objCDOSYSMail = Nothing Set objCDOSYSCon = Nothing end if %>