Sample Form

Please provide the following information, then click Submit:

 

First Name:

 

Last Name:

 

Title: Mr. Ms.

<% If Request.Form("lname")<>"" then %>

Thank you

Thank you, <%Title = Request.Form("title") LastName = Request.Form("lname") If Title = "mr" Then%> Mr. <%=LastName%>, <%ElseIf Title = "ms" Then%> Ms. <%=LastName%>, <%Else%> <%=Request.Form("fname") & " " & LastName %> <%End If%> for your order.

<%End if %>