Service Request Form (Short)

<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("AdBizForm_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(21) Dim arFormDBFields0(21) Dim arFormValues0(21) arFormFields0(0) = "Addr1" arFormDBFields0(0) = "Addr1" arFormValues0(0) = Request("Addr1") arFormFields0(1) = "Addr2" arFormDBFields0(1) = "Addr2" arFormValues0(1) = Request("Addr2") arFormFields0(2) = "Referred_Person" arFormDBFields0(2) = "Referred_Person" arFormValues0(2) = Request("Referred_Person") arFormFields0(3) = "SecondCategory" arFormDBFields0(3) = "SecondCategory" arFormValues0(3) = Request("SecondCategory") arFormFields0(4) = "Company" arFormDBFields0(4) = "Company" arFormValues0(4) = Request("Company") arFormFields0(5) = "Fax" arFormDBFields0(5) = "Fax" arFormValues0(5) = Request("Fax") arFormFields0(6) = "Email" arFormDBFields0(6) = "Email" arFormValues0(6) = Request("Email") arFormFields0(7) = "City" arFormDBFields0(7) = "City" arFormValues0(7) = Request("City") arFormFields0(8) = "FreeEntry" arFormDBFields0(8) = "FreeEntry" arFormValues0(8) = Request("FreeEntry") arFormFields0(9) = "Phone" arFormDBFields0(9) = "Phone" arFormValues0(9) = Request("Phone") arFormFields0(10) = "kwd1" arFormDBFields0(10) = "kwd1" arFormValues0(10) = Request("kwd1") arFormFields0(11) = "Zip" arFormDBFields0(11) = "Zip" arFormValues0(11) = Request("Zip") arFormFields0(12) = "kwd2" arFormDBFields0(12) = "kwd2" arFormValues0(12) = Request("kwd2") arFormFields0(13) = "kwd3" arFormDBFields0(13) = "kwd3" arFormValues0(13) = Request("kwd3") arFormFields0(14) = "Country" arFormDBFields0(14) = "Country" arFormValues0(14) = Request("Country") arFormFields0(15) = "kwd4" arFormDBFields0(15) = "kwd4" arFormValues0(15) = Request("kwd4") arFormFields0(16) = "Website" arFormDBFields0(16) = "Website" arFormValues0(16) = Request("Website") arFormFields0(17) = "State" arFormDBFields0(17) = "State" arFormValues0(17) = Request("State") arFormFields0(18) = "Category" arFormDBFields0(18) = "Category" arFormValues0(18) = Request("Category") arFormFields0(19) = "kwd5" arFormDBFields0(19) = "kwd5" arFormValues0(19) = Request("kwd5") arFormFields0(20) = "ContactPersonName" arFormDBFields0(20) = "ContactPersonName" arFormValues0(20) = Request("ContactPersonName") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type" End If If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close Session("FP_SavedFields")=arFormFields0 Session("FP_SavedValues")=arFormValues0 Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") Response.Redirect "../ConfimationsForms/confirm_AddBusinessFREE.asp" End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Service Request Form (Short)

** =Required Information.
Your FREE membership...

*Company Name:

*Point Of Contact Name:

*Category Describing Your Business:

Secondary Category:

*Address:

*City:

*State/Region:

Zip Code:

*Phone:

Fax:

*Country:

*E-mail Address:

Website URL:

Keywords Describing Your Business:

	keyword 1
	keyword 2
	keyword 3
	keyword 4
	keyword 5

FREE ENTRY INTO SEARCH ENGINE:

(Note: Valid Entry is "Yes". Do Not Change)

*Who Referred You To Us?

(Please type name here )