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Thread: Contact Form with User Selected Recipient?

  1. #1
    Join Date
    Apr 2011
    Posts
    13

    Contact Form with User Selected Recipient?

    Hi all, I'm trying to set up a form for a online payday loan application and I need a script that will mail the results of the form to a user selected recipient. If I could do it in PHP I'd have no problem, but unfortunately, it's a Windows server and I can't run PHP, so I'm stuck with ASP.

    Here is my form code:

    Code:
    <form action="formprocess.asp" method="post">
            
            <h1>Contact Information:</h1>
            
      <table width="730" border="1px" cellpadding="5">
      <tr>
        <td id="formlabel" width="80">First Name:</td>
        <td width="190"><input class="textbox" name="FIRST_NAME" type="text" /></td>
        <td id="formlabel" width="80">Last Name:</td>
        <td width="190"><input class="textbox" name="LAST_NAME" type="text" /></td>
        <td id="formlabel" width="80">Date of Birth:</td>
        <td width="190"><input class="textbox" name="DOB" type="text" /></td>
      </tr>
      <tr>
        <td id="formlabel" width="80">SIN:</td>
        <td width="190"><input class="textbox" name="SIN" type="text" /></td>
        <td class="empty" width="80">&nbsp;</td>
        <td class="empty" width="190">&nbsp;</td>
        <td class="empty" width="80">&nbsp;</td>
        <td class="empty" width="190">&nbsp;</td>
      </tr>
      <tr>
        <td id="formlabel" width="80">Street Address:</td>
        <td width="190"><input class="textbox" name="STREET_ADDRESS" type="text" /></td>
        <td id="formlabel" width="80">City:</td>
        <td width="190"><input class="textbox" name="CITY" type="text" /></td>
        <td id="formlabel" width="80">Province:</td>
        <td width="190">
        
        <select name="PROVINCE">
        	<option value="BC">British Columbia</option>
            <option value="AB">Alberta</option>
        </select>
        
        </td>
      </tr>
      <tr>
        <td id="formlabel" width="80">Home Phone:</td>
        <td width="190"><input class="textbox" name="HOME_PHONE" type="text" /></td>
        <td id="formlabel" width="80">Cell Phone:</td>
        <td width="190"><input class="textbox" name="CELL_PHONE" type="text" /></td>
        <td id="formlabel" width="80">Time at Address:</td>
        <td width="190">
        
        <select name="TIME_ADDRESS">
        	<option value="LESS_3MONTH">&lt; 3 Months</option>
            <option value="LESS_YEAR">&lt; 1 Year</option>
            <option value="1">1 Year</option>
            <option value="2">2 Years</option>
            <option value="3">3 Years</option>
            <option value="4">4 Years</option>
            <option value="5">5 Years</option>
            <option value="MORE_FIVE">&gt; 5 Years</option>
        </select>
        
        </td>
      </tr>
    </table>
    
    <h1>Employment Information:</h1>
            
      <table width="730" border="1px" cellpadding="5">
      <tr>
        <td id="formlabel" width="43">Employer Name:</td>
        <td width="190"><input class="textbox" name="EMPLOYER_NAME" type="text" /></td>
        <td id="formlabel" width="80">Job Title:</td>
        <td width="190"><input class="textbox" name="JOB_TITLE" type="text" /></td>
        <td id="formlabel" width="80">Employer Phone:</td>
        <td width="190"><input class="textbox" name="EMPLOYER_PHONE" type="text" /></td>
      </tr>
      <tr>
        <td id="formlabel" width="80">Time at Employer:</td>
        <td width="190">
        
        <select name="TIME_EMPLOYER">
        	<option value="LESS_3MONTH">&lt; 3 Months</option>
        	<option value="LESS_YEAR">&lt; 1 Year</option>
            <option value="1">1 Year</option>
            <option value="2">2 Years</option>
            <option value="3">3 Years</option>
            <option value="4">4 Years</option>
            <option value="5">5 Years</option>
            <option value="MORE_FIVE">&gt; 5 Years</option>
        </select>
        
        </td>
        <td id="formlabel" width="80">Payment Schedule:</td>
        <td width="190">
        
        <select name="PAY_SCHEDULE">
        	<option value="WEEKLY">Weekly</option>
            <option value="BIWEEKLY">Bi-Weekly</option>
            <option value="MONTHLY">Monthly</option>
        </select>
        
        </td>
        <td id="formlabel" width="80">Monthly Gross ($):</td>
        <td width="190"><input class="textbox" name="MONTHLY_GROSS" type="text" /></td>
      </tr>
      <tr>
        <td id="formlabel" width="80">Income Type:</td>
        <td width="190">
        
        <select name="INCOME_TYPE">
        	<option value="REGULAR">Regular Employment</option>
            <option value="CTB">Child Tax Benefit</option>
            <option value="PENSION">Pension</option>
            <option value="EI">Employment Insurance</option>
            <option value="OTHER">Other</option>
        </select>
        
        </td>
        <td id="formlabel" width="80">If Other, Describe:</td>
        <td width="190"><input class="textbox" name="INCOMETYPE_OTHER" type="text" /></td>
        <td id="formlabel" width="80">Direct Deposit:</td>
        <td width="190"><input name="DIRECT_DEPOSIT" type="checkbox" value="YES" /></td>
      </tr>
      
    </table>
    
    <h1>LOAN INFORMATION:</h1>
            
      <table width="730" border="1px" cellpadding="5">
      <tr>
        <td id="formlabel" width="80">Bank Name:</td>
        <td width="190"><input class="textbox" name="BANK_NAME" type="text" /></td>
        <td id="formlabel" width="80">Loan Amount Requested:</td>
        <td width="190"><input class="textbox" name="AMOUNT_REQUESTED" type="text" /></td>
        <td id="formlabel" width="80">Requested Speedy Cash Location:</td>
        <td width="190">
        
        <select name="RECIPIENT">
        	<option value="trobinson@scash.ca">---BRITISH COLUMBIA---</option>
            <option value="krink@scash.ca">Chilliwack</option>
            <option value="krink@scash.ca">Cranbrook</option>
            <option value="djenkins@scash.ca">Dawson Creek</option>
            <option value="djenkins@scash.ca">Kamloops</option>
            <option value="krink@scash.ca">Penticton</option>
            <option value="trobinson@scash.ca">Prince George</option>
            <option value="djenkins@scash.ca">Terrace</option>
            <option value="krink@scash.ca">Merrit</option>
            <option value="trobinson@scash.ca">---------ALBERTA---------</option>
            <option value="djenkins@scash.ca">Grand Prairie</option>
            <option value="krink@scash.ca">Lethbridge</option>
            <option value="krink@scash.ca">Red Deer</option>
            <option value="djenkins@scash.ca">Lloydminster</option>
            
        </select>
          
        </td>
      </tr>
      
    </table><br />
    <p>Applicant must be at least 19 years of age in BC, and 18 years of age in Alberta to apply.<br />
    All sections must be complete in order to qualify. By clicking submit, applicant agrees that <br />
    all information is true and accurate to the best of his or her knowledge.</p>
    <br />
    
    <input type="submit" />
    <input type="reset" />
    
            
            </form>
    I need the script to send an email to the email address in the last SELECT item named RECIPIENT. Security is also a must, as personal information will be sent. Can anybody help me out? I'm lost when it comes to ASP...

    Thanks in advance!

  2. #2
    Join Date
    Jan 2008
    Location
    Florida
    Posts
    1,227
    If you are accepting any personal information that should be secure, NEVER email that information. You should setup a database to store the information (even encrypted if you like).. and access all info over a SSL secure connection.

    This is not something that we could simply "show you some code" to make happen.

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