<%@ 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 & "

Visual Culture 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 = "Visual Culture Order" objMail.Send Set objMail = Nothing End Sub %> <% End If %>

Thank you for your order!

We will contact you shortly about payment.







<% Else %>

VISUAL CULTURE 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 able to enter your Credit Card information.  

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

Thank you for your order!

<% End If %>