YOUR CAR REPLACEMENT PROGRAM









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Personal Particulars / Butir-Butir Peribadi



Name/ Nama
Email Address / Alamat Emel
Home Address / Alamat Rumah
Telephone No. / No Telepon
Fax No. / No. Fax
NIRC No. New / Baru
NIRC No. Old / Lama
Driving Licence
Registration No. / No. Pendaftaran
Year of Registration / Tahun Pendaftaran
Model / Model
Type of Vehicle / Jenis Kenderaan
Cash / Tunai
Cheque No. / No. Cek
Credit Card No. / No Kad Kredit
Name of Credit Card
Expiry Date / Tempoh Tamat
Comments
   
 

<% 'If the form has been submitted execute the following code Else 'receive the form values Dim sName, sEmail, sFeedback sName=Request.Form("txtName") sEmail=Request.Form("txtEmail") sFeedback=Request.Form("txtFeedback") ' create the HTML formatted email text Dim sEmailText sEmailText = sEmailText & "" sEmailText = sEmailText & "" sEmailText = sEmailText & "HTML Email" sEmailText = sEmailText & "" sEmailText = sEmailText & "" sEmailText = sEmailText & "Feedback message from: " & sName & "
" sEmailText = sEmailText & "Message:" & sFeedback & "
" sEmailText = sEmailText & "Date & Time:" & Now() & "
" sEmailText = sEmailText & "IP :" & Request.ServerVariables("REMOTE_ADDR") sEmailText = sEmailText & "" sEmailText = sEmailText & "" 'create the mail object Set NewMailObj=Server.CreateObject("CDONTS.NewMail") NewMailObj.From=sEmail 'This is the email of the feedback sender NewMailObj.To = "info@mooshicar.com" 'change to your address NewMailObj.Subject = "Sign Up" NewMailObj.Body = sEmailText 'you need to add these 2 lines for the mail to be sent in HTML format 'remove them and the email will be sent in Text format NewMailObj.BodyFormat = 0 NewMailObj.MailFormat = 0 NewMailObj.Send Set NewMailObj=Nothing Response.write "
Thank you for applying.
" Response.write "We will get back to you if necessary.
" End If %>