<% if Request("submit") <> "" then Dim objCDO Set objCDO = Server.CreateObject("CDO.Message") Dim objCDOConf Set objCDOConf = Server.CreateObject("CDO.Configuration") With objCDOConf.Fields .Item(cdoSendUsingMethod) = 2 .Item(cdoSMTPServer) = "mail-fwd" .Item(cdoSMTPServerPort) = 25 .Item(cdoSMTPconnectiontimeout) = 10 .Update End With Set objCDO.Configuration = objCDOConf ' Be sure to use a valid email addresses below: objCDO.From = "rx@springviewpharmacy.com" objCDO.To = "rx@springviewpharmacy.com" objCDO.Subject = "FormMail from " & Request.ServerVariables("URL") objCDO.TextBody = "FormMail from " & Request.ServerVariables("URL") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Name: " objCDO.TextBody = objCDO.TextBody & Request("Name") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Company Name: " objCDO.TextBody = objCDO.TextBody & Request("Company Name") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Phone: " objCDO.TextBody = objCDO.TextBody & Request("Phone") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "Email: " objCDO.TextBody = objCDO.TextBody & Request("Email") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "regarding: " objCDO.TextBody = objCDO.TextBody & Request("regarding") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "ref: " objCDO.TextBody = objCDO.TextBody & Request("ref") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.TextBody = objCDO.TextBody & "comment: " objCDO.TextBody = objCDO.TextBody & Request("comment") objCDO.TextBody = objCDO.TextBody & chr(10) & chr(13) objCDO.Send 'Clean-up Set objCDO = Nothing Set objCDOConf = Nothing ' Happy response. If you would rather, ' change the following to ' Response.Redirect "thanks.html" or similar Response.Redirect("thankyou.asp") Response.End end if %> Refill Prescriptions

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SPRINGVIEW PHARMACY
4 Elmwood Avenue
IRVINGTON, NJ 07111
PHONE: (973) 372-1300
FAX:   (973) 372-0303

E-mail us: rx@springviewpharmacy.com

 

 

 

 

 

 

 

 

 

 



 
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