Order Form

<% If request("Button")="Send Request" then Set objMail = Server.CreateObject("CDONTS.NewMail") For each sRequest in Request.Form Select Case sRequest Case "From" strBody = request(sRequest) If IsNull(strBody) = True OR IsEmpty(strBody) = True OR strBody = "" Then strBody = "Null" objMail.From=strBody Case else strBody = request(sRequest) If IsNull(strBody) = True OR IsEmpty(strBody) = True OR strBody = "" Then strBody = "Null" sBody=sBody & sRequest & " - " & strBody & chr(13) End select Next objMail.Body=sBody 'You can change EMAIL address and SUBJECT mailTo = "karler@southwesterngold.com" objMail.To = mailTo objMail.Subject="Results from a form" objMail.Send set objMail = nothing 'This is where you change what the Result page says response.write "Thank You For Your Request. We will either email or call you when we have virtialized your domain." Else %>

Name:

Address:

City:

State: Zip:

Telephone:

Email:

Order Here:


Check/Money Order (Payable to Southwestern Gold Inc.)

Comment:

<% End if %>

Terms: Payment must be made in full, cashier's checks, or money order. Personal checks must clear our bank. Please allow ten working days. Merchandise will be shipped registered mail to your address.

6909 Menaul Boulevard N.E. Suite F
Albuquerque, New Mexico 87110
Telephone: (505) 881-3636   (800) 545-6575
FAX: (505) 883-8957

Office Hours Mon.-Fri. 9-4:30