<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Accident Care Trust - Donate Form
<% if request("hdtxtFlag")="1" then txtAmount=Request.form("txtAmount") txtName=Request.form("txtName") txtCompany=Request.form("txtCompany") txtAddress=Request.form("txtAddress") txtCity=Request.form("txtCity") txtState=Request.form("txtState") txtCode=Request.form("txtCode") txtCountry=Request.form("txtCountry") txtPhone=Request.form("txtPhone") txtEmail=Request.form("txtEmail") Subject = "Donate submission from Accident Care Trust Trust site Visitor" Body = "Following message has been sent by - " & txtName&"

" Body = Body & "Amount : " & txtAmount & "
" Body = Body & "Company : " & txtCompany & "
" Body = Body & "Address : " & txtAddress & "
" Body = Body & "City : " & txtCity & "
" Body = Body & "State : " & txtState & "
" Body = Body & "Zip Code : " & txtCode & "
" Body = Body & "Country : " & txtCountry & "
" Body = Body & "Email : " & txtEmail & "
" if txtPhone<>"" then Body = Body & "Phone : " & txtPhone & "
" End if Set myMail = CreateObject("CDO.Message") myMail.From="info@accidentcaretrust.com" myMail.To="info@accidentcaretrust.com" myMail.Subject=Subject myMail.HTMLBody=Body myMail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/sendusing")=2 myMail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpserver") ="ibee01.org" myMail.Configuration.Fields.Item ("http://schemas.microsoft.com/cdo/configuration/smtpserverport") =25 myMail.Configuration.Fields.Update on error resume next myMail.Send set myMail=nothing Response.Redirect("donatenow.asp?sc=1") Elseif Request.QueryString("sc")=1 then %>

 

Donate Now

Thank You! We appreciate your co-oparation
<% else%>
Donate Now
I am making a gift of:
*Amount :
Fill in your name and address to ensure correct preparation.
*Name:
*Company/Organization:
*Address:
*City:
*State:
*ZIP or Postal Code:
*Country:
*Email Address:
 I may be contacted by e-mail.
  Telephone Number :
  
<% end if%>