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Home > BRS Relocations Services > Estimate Form

Business Relocation Services Estimate Form

<% 'If request.servervariables("HTTP_METHOD")="POST" Then If request("submit")="Submit" Then Set MyMail = CreateObject("cdo.message") MyMail.From = "brsrelocations@brinkster.net" MyMail.To = "contact@brsrelocations.com" MyMail.Subject = "BRSRelocations.com Estimate Form " MyMail.TextBody = "Company Name: " & Request("companyname") & vbcrlf & vbcrlf & "Contact Name: " & Request("contactname") & vbcrlf & vbcrlf & "Address: " & Request("address") & vbcrlf & vbcrlf & "City: " & Request("city") & vbcrlf & vbcrlf & "State/Prov.: " & Request("state") & vbcrlf & vbcrlf & "Zip: " & Request("zip") & vbcrlf & vbcrlf & "Email: " & Request("email") & vbcrlf & vbcrlf & "Phone: " & Request("phone") & vbcrlf & vbcrlf & "Fax: " & Request("fax") & vbcrlf & vbcrlf & "Move Date: " & Request("datem") & "/" & Request("dated") & "/" & Request("datey") & vbcrlf & vbcrlf & "Move From" & vbcrlf & vbcrlf & "Address:" & Request("fromaddress") & vbcrlf & "Apt/Floor:" & Request("fromapt") & vbcrlf & "City:" & Request("fromcity") & vbcrlf & "State:" & Request("fromstate") & vbcrlf & "Zip:" & Request("fromzip") & vbcrlf & vbcrlf & "Move To:" & vbcrlf & vbcrlf & "Address:" & Request("toaddress") & vbcrlf & "Apt/Floor:" & Request("toapt") & vbcrlf & "City:" & Request("tocity") & vbcrlf & "State:" & Request("tostate") & vbcrlf & "Zip:" & Request("tozip") & vbcrlf & vbcrlf & "Number of Employees: " & Request("numberemployees") & vbcrlf & vbcrlf & "Square Footage: " & Request("squarefootage") & vbcrlf & vbcrlf & "Send Info: " & Request("pleasesend") & vbcrlf & vbcrlf & "Please Call: " & Request("pleasecall") & vbcrlf & vbcrlf & "Comments: " & Request("comments") MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = 2 MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = "sendmail.brinkster.com" MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/sendusername") = "brsrelocations@brinkster.net" MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/sendpassword") = "jlinares20" MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpauthenticate") = 1 MyMail.Configuration.Fields.Item("http://schemas.microsoft.com/cdo/configuration/smtpserverport") = 25 MyMail.Configuration.Fields.Update MyMail.SEND Response.Write "Your information has been sent. Thank you.

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*Company Name:
*Contact:
*Address:
*City:
*State/Prov:
*Zip/Postal Code:
*Email Address:
*Phone:
Fax Number:
*Move Date:	"> "> "> (MM/DD/YY)
Moving From
*Address:
*Apt/Floor:
*City:
*State:
*Zip:	" size="5" maxlength="5">
Moving To
*Address:	" size="60">
*Apt/Floor:	" size="60">
*City:	" size="30">
*State:
*Zip:	" size="5" maxlength="5">
*Required Information
Number of Employees Moving:
Square Footage Moving:
Please Send Information:
Please Call to Schedule an Appointment:
Comments / Questions:

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