<%@ Language="VBScript" %> <% On error resume next Dim Name Dim Address1 Dim Address2 Dim Address3 Dim City Dim State Dim Zip Dim SubscriberNo Dim EMail Dim Msg dim DateAdded Public rsMessage Public cnDB Name = "" Session("ErrMsg") = "" Err.Clear If isEmpty(Session("dbConnectionMsg")) then Response.Redirect "Login.asp" End if If Request.Form("btnCancel") = "Cancel" then Response.Redirect "Login.asp" End if If Request.Form("btnSubmit") = "Submit" then Name = Left(Request.Form("Name"),50) Address1 = Left(Request.Form("Address1"),50) Address2 = Left(Request.Form("Address2"),50) Address3 = Left(Request.Form("Address3"),50) City = Left(Request.Form("City"),50) State = Left(Request.Form("State"),50) Zip = Left(Request.Form("Zip"),50) SubscriberNo = Left(Request.Form("SubscriberNo"),50) EMail = Left(Request.Form("EMail"),255) Msg = Request.Form("Msg") DateAdded = Date() If Name <> "" then Set cnDB = CreateObject("ADODB.Connection") cnDB.ConnectionString = Session("dbConnectionMsg") cnDB.Open If err.number = 0 then Set rsMessage = cnDB.Execute("INSERT INTO tblMessage" & _ " (Name, Address1, Address2, Address3, City, State," & _ " Zip, SubscriberNo, Email, Msg, DateAdded)" & _ " SELECT" & _ " '" & Name & "' AS ExName," & _ " '" & Address1 & "' AS ExAdd1," & _ " '" & Address2 & "' AS ExAdd2," & _ " '" & Address3 & "' AS ExAdd3," & _ " '" & City & "' AS ExCity," & _ " '" & State & "' AS ExState," & _ " '" & Zip & "' AS ExZip," & _ " '" & SubscriberNo & "' AS ExSub," & _ " '" & EMail & "' AS ExEMail," & _ " '" & Msg & "' AS ExMsg," & _ " " & Date() & " AS ExDtAdd;") rsMessage.close End if cnDB.close set cnDB = Nothing Response.Redirect "Login.asp" Else Session("ErrMsg") = " Name is a required Field" End if End if %> Contact Family Medical
<% If Not len(Session("ErrMsg")) = 0 then Response.Write "

" Response.Write "Error: " & Session("ErrMsg")& "

" End if %>
Name:

Address:

City:

   State       Zip  

Phone:

   E-mail Address: 

Subscriber No:

Message: