<%
If Request.Form("btnSend").Count > 0 Then
organization = trim(request.form("organization"))
contact = trim(request.form("contact"))
director = trim(request.form("director"))
phone = trim(request.form("phone"))
email = trim(request.form("email"))
address = trim(request.form("address"))
city = trim(request.form("city"))
state = trim(request.form("state"))
zip = trim(request.form("zip"))
message1 = trim(request.form("message1"))
message2 = trim(request.form("message2"))
message3 = trim(request.form("message3"))
msg = "Online AED REQUEST FORM
Organization Information
" & chr(10) & chr(10)
msg = msg & "Organization Name : " & organization & chr(10)
msg = msg & "
Organization Contact : " & contact & chr(10)
msg = msg & "
Medical Director : " & director & chr(10)
msg = msg & "
Phone Number : " & phone & chr(10)
msg = msg & "
Email Address : " & email & chr(10)
msg = msg & "
Organization Address : " & address & chr(10)
msg = msg & "
City : " & city & chr(10)
msg = msg & " State : " & state & chr(10)
msg = msg & " Zip : " & zip & chr(10)
msg = msg & "AED Information Request
About the Organization:
" & message1 & chr(10)
msg = msg & "
How will the AED be utilized?
" & message2 & chr(10)
msg = msg & "
The area and population your organization covers.
" & message3 & chr(10)
msg = msg & "
"
Set objMessage = CreateObject("CDO.Message")
objMessage.Subject ="AED Request"
objMessage.Sender = Request.Form("contact")
objMessage.From = "AEDRequestform@mdfire.org"
objMessage.To = "mdfire@popmail.skypoint.com"
'objMessage.Bcc = Request.Form("bcc")
'objMessage.Cc = Request.Form("cc")
objMessage.HTMLBody = msg
objMessage.Send
Response.Redirect("aed-complete.html")
End If
%>
Mdewakanton Emergency Services
