<% function TestCaptcha(byval valSession, byval valCaptcha) dim tmpSession valSession = Trim(valSession) valCaptcha = Trim(valCaptcha) if (valSession = vbNullString) or (valCaptcha = vbNullString) then TestCaptcha = false else tmpSession = valSession valSession = Trim(Session(valSession)) Session(tmpSession) = vbNullString if valSession = vbNullString then TestCaptcha = false else valCaptcha = Replace(valCaptcha,"i","I") if StrComp(valSession,valCaptcha,1) = 0 then TestCaptcha = true else TestCaptcha = false end if end if end if end function public Function Fix(strA) if trim(strA) <> "" then Fix = replace(strA,"'","''") end if End Function if request("submit")="Submit" then if TestCaptcha("ASPCAPTCHA", Request.Form("captchacode")) then Company=request.form("company") Contact=request.form("contact") Title=request.form("title") Address1=request.form("address1") Address2=request.form("address2") City=request.form("city") UState=UCase(request.form("state")) State=request.form("state") Zip=request.form("zip") Email=request.form("email") Phone=request.form("phone") Fax=request.form("fax") Chkadvertisement=request.form("chkadvertisement") Chkreferral=request.form("chkreferral") Chktradeshow=request.form("chktradeshow") Chkwebsearch=request.form("chkwebsearch") Chkother=request.form("chkother") Chkpresentation=request.form("chkpresentation") Chkschedule=request.form("chkschedule") Comments=request.form("comments") vMsg1 = "CONTACT FORM SUBMITTAL" & "

" vMsg1 = vMsg1 & "This is the information submitted to the contact form." & "

" vMsg1 = vMsg1 & "Company: " & "      " & Company & "
" vMsg1 = vMsg1 & "Contact: " & "      " & Contact & "
" vMsg1 = vMsg1 & "Title: " & "        " & Title & "
" vMsg1 = vMsg1 & "Address 1: " & "    " & Address1 & "
" vMsg1 = vMsg1 & "Address 2: " & "    " & Address2 & "
" vMsg1 = vMsg1 & "City: " & "         " & City & "
" vMsg1 = vMsg1 & "State: " & "        " & State & "
" vMsg1 = vMsg1 & "Zip: " & "          " & Zip & "
" vMsg1 = vMsg1 & "E-Mail: " & "       " & Email & "
" vMsg1 = vMsg1 & "Phone: " & "        " & Phone & "
" vMsg1 = vMsg1 & "Fax: " & "          " & Fax & "
" vMsg1 = vMsg1 & "Advertisement? " & Chkadvertisement & "
" vMsg1 = vMsg1 & "Referral? " & "     " & Chkreferral & "
" vMsg1 = vMsg1 & "Tradeshow? " & "    " & Chktradeshow & "
" vMsg1 = vMsg1 & "Web search? " & "   " & Chkwebsearch & "
" vMsg1 = vMsg1 & "Other? " & "        " & Chkother & "
" vMsg1 = vMsg1 & "Presentation? " & " " & Chkpresentation & "
" vMsg1 = vMsg1 & "Schedule? " & "     " & Chkschedule & "
" vMsg1 = vMsg1 & "Comments: " & "     " & Comments & "
" vMsg1 = vMsg1 & "
" vMsg1 = vMsg1 & "Please contact the user if need be." & "

" FirstName=Contact Email= Email myMSG= vMsg1 Set Mailer = Server.CreateObject("SMTPsvg.Mailer") Mailer.FromName = "Webform from " & Contact Mailer.FromAddress = Email Mailer.RemoteHost = "mail2.siteserver.net" Mailer.AddRecipient "Sabine Kutt", "sabine@ar-express.net" Mailer.AddRecipient "Edward Kutt", "asap@msn.com" Mailer.AddBCC "Tom Kriete", "Tom.Kriete@mycomputerworx.com" Mailer.Subject = "New DIABCO Contact Form Submittal!" Mailer.ContentType = "text/html" Mailer.BodyText = myMSG if Mailer.SendMail then response.Redirect("thankscon.html") else Response.Write "Mail failure. Check mail host server name and tcp/ip connection..." Response.Write "

" & Mailer.Response end if else Response.Write("You entered the wrong code.") end if end if %> DIABCO – Medical Billing Software – Electronic Medical Billing Software Medical Practice Billing Software

Corporate Office
DIABCO-
Healthcare Software Solutions, LLC

660 Linton Blvd
Suite 207-A
Delray Beach, FL 33444


(561) 330-2662 Voice
(561) 330-2692 Fax
Email: sabine@ar-express.net


1-800-864-6210


Company Name:
Contact Name:
Title:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Email:


How did you hear about us?
Advertisement    Referral    Tradeshow    Web Search    Other

Comments/Questions?

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