<% option explicit %> Wagner Insurance Agency <% private sub DisplayForm() %>
Request for Quote
 
Name:   
Street Address:   
City:   
State:   
Zip Code:   
Phone Number:   
Annual Sales:   
Number of Employees:   
Payroll:   
Number of Vehicles Owned by Company:   
Nature and Descrition of Business:   
Name of current insurance company:   




<% end sub private sub DisplayResponse() dim strMessage, _ strEMail strEMail = "Name: " & request.form("name") & vbCrlf strEMail = strEMail & "Address: " & request.form("strAddr") & vbCrlf & " " & _ request.form("city") & ", " & request.form("state") & " " & request.form("zip") & vbCrlf strEMail = strEMail & "Phone: " & request.form("phone") & vbCrlf strEMail = strEMail & "Annual Sales: " & request.form("sales") & vbCrlf strEMail = strEMail & "Number of Employees: " & request.form("employee") & vbCrlf strEMail = strEMail & "Payroll: " & request.form("payroll") & vbCrlf strEMail = strEMail & "Number of Vehicles: " & request.form("vehicles") & vbCrlf strEMail = strEMail & "Description of business: " & request.form("desc") & vbCrlf strEMail = strEMail & "Current Insurance Company: " & request.form("insure") & vbCrlf ' ' SendMail(v_strBody, v_strSender, v_strRecipient, v_strSubject, v_strHTMLFlag) SendMail strEMail, _ "webmaster@wagnerinsurance.com", _ "insure@wagnerinsurance.com", _ "business insurance quote request", _ "N" 'SendMail strEMail, _ ' "webmaster@wagnerinsurance.com", _ ' "douglas.estep@webtechinfo.com", _ ' "business insurance quote request", _ ' "N" strMessage = "Your request for quote has been sent. Someone will contact you shortly reguarding your request." strMessage = strMessage & "
need our services sooner please feel free to call us at
(937) 223-2232.

" response.write strMessage end sub private sub DisplayHeader() %>



<% end sub %>
<% 'DisplayHeader If Request.Querystring("Type") <> "" Then DisplayResponse Else DisplayForm end if %>