<% reqSend = Replace(Request("Send"),"'","''") FName = Replace(Request("FName"),"'","''") LName = Replace(Request("LName"),"'","''") Email = Replace(Request("Email"),"'","''") OPhone = Replace(Request("Ophone"),"'","''") Mobile = Replace(Request("Mobile"),"'","''") Fax = Replace(Request("Fax"),"'","''") Company = Replace(Request("Company"),"'","''") Address = Replace(Request("Address"),"'","''") City = Replace(Request("City"),"'","''") State = Replace(Request("State"),"'","''") Zip = Replace(Request("Zip"),"'","''") Country = Replace(Request("Country"),"'","''") How_hear = Replace(Request("How_Hear"),"'","''") Comments = Replace(Request("Comments"),"'","''") Body = Body & "First Name: " & FName & "
Last Name: " & LName & "
Email: " & Email & "
Phone Number: " & OPhone & "
Mobile: " & Mobile & "
Fax: " & Fax & "
Company: " & Company & "
Street: " & Address & "
City: "& City & "
State: " & State & "
Zip: " & Zip & "
Country: " & Country & "
How they heard about us: " & How_Hear & "
Comments: " & Comments If reqSend <> "" Then Set Mail = Server.CreateObject("Persits.MailSender") Mail.Queue = True Mail.From = "broker.registration@themarkersclub.com" ' From address Mail.FromName = "Broker Registration" ' optional Mail.AddAddress "michael@themarkersclub.com" ' message subject Mail.Subject = "Broker Registration Submission From www.themarkersclub.com" ' message body Mail.Body = Body Mail.IsHTML = TRUE strErr = "" bSuccess = False On Error Resume Next ' catch errors Mail.Send ' send message If Err <> 0 Then ' error occurred strErr = Err.Description else bSuccess = True End If End If %>

Please complete the form below. * are required fields.
* First Name:
* Last Name:
* Email:
Office Phone:
Mobile:
Fax:
Company:
Address:
City:
State:
Zip:
Country:
How did you hear about the Broker Referral Program:
Comments:

<% If strErr <> "" Then %> Error occurred: <% = strErr %> <% End If %> <% If bSuccess Then %> Thank you for your submission. Someone will contact you within 48 hours. <% End If %>