<%@ LANGUAGE=VBScript %> <% Response.Buffer = True %>
 
 
<% If Request.Form("Submitted") = "Yes" Then vDebug ="0" If vDebug = "1" Then %> SQL = "<%= SQL %>"
Name:
<%= Request.Form("FirstName") %>
<%= Request.Form("LastName") %>
<%= Request.Form("Email") %>
Address:
<%= Request.Form("Address1") %>
<%= Request.Form("Address2") %>
<%= Request.Form("City") %>
<%= Request.Form("ST") %>
<%= Request.Form("Zip") %>
Phone:
<%= Request.Form("Phone") %>
<% Else %> <% Sub SendEmailMessage() Dim objMail Dim strBody Set objMail= CreateObject("CDONTS.Newmail") 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 & "

Creation Unit-Study Order

" & chr(10) strBody = strBody & "
" strBody = StrBody & "Name: " & Request.Form("FirstName") & " " & Request.Form("LastName") & chr(10) strBody = strBody & "
" strBody = StrBody & "Email: " & Request.Form("Email") & chr(10) strBody = strBody & "
" strBody = StrBody & "Address1: " & Request.Form("Address1") & chr(10) strBody = strBody & "
" strBody = StrBody & "Address2: " & Request.Form("Address2") & chr(10) strBody = strBody & "
" strBody = StrBody & "City: " & Request.Form("City") & chr(10) strBody = strBody & "
" strBody = StrBody & "ST: " & Request.Form("ST") & chr(10) strBody = strBody & "
" strBody = StrBody & "Zip: " & Request.Form("Zip") & chr(10) strBody = strBody & "
" strBody = StrBody & "Phone: " & Request.Form("Phone") & chr(10) strBody = strBody & "
" strBody = strBody & "" objMail.BodyFormat = 0'HTML objMail.Body = strBody objMail.MailFormat = 0'Mime format objMail.Importance = 2'High objMail.From = "Opt In form" objMail.To = "sara@thegreatnessfactor.com" objMail.Subject = "Creation Unit-Study Order" objMail.Send Set objMail = Nothing End Sub %> <% End If %>

Thank you for your order!

We will contact you shortly about payment.







<% Else %>

CREATION UNIT STUDY ORDER FORM

First Name:
Last Name:
Email Address:
Address 1:
Address 2:
City:
State/PR:
Zip/PC:
Phone #:
 

 

Once you've submitted the order form above you will receive an email statement for your order.  Simply click on the PAY NOW button in that email and you will be taken to our secure sight on Paypal to enter your Credit Card information.  

When payment is received, your Creation e-study will be sent to you via email! 

Thank you for your order!

<% End If %>