Contact Form with User Selected Recipient?

[khaag]

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:

<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!

[yamaharuss]

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.