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  1. #1
    New to the CF scene
    Join Date
    Aug 2004
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    Help - Not Receiving Form Results

    I have a client that has several form on there website. for some reason this one is not working. can any one take a look at this asp code and tell me whats wrong. The form is directed to this page...... Heres the code. Thanks in advance for all the help!

    <%
    strMsg = strMsg & "<form>"
    strMsg = strMsg & "<table width='780' border='0' align='center' cellpadding='0' cellspacing='0'>"
    strMsg = strMsg & "<tr><td class='main'>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td class='main'><strong>Fen-Phen Application </strong></td></tr><tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td><u class='main'>CLIENT INFORMATION</u></td></tr><tr><td>&nbsp;</td></tr>"


    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td>Broker Code: "&REQUEST("BrokerCode")&"</td></tr><tr><td>&nbsp;</td></tr>"

    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td><table width='700' height='202' border='0' cellpadding='0' cellspacing='0'>"
    strMsg = strMsg & "<tr valign='top' width='78'>"
    strMsg = strMsg & "<td class='main2' width='78'>Name:</td>"
    strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Ref_Name")&"</td>"
    strMsg = strMsg & "<td width='50' rowspan='6'>&nbsp;</td>"
    strMsg = strMsg & "<td width='78'>&nbsp;</td>"
    strMsg = strMsg & "<td width='78'>&nbsp;</td>"
    strMsg = strMsg & "<td rowspan='6' width='50'>&nbsp;</td>"
    strMsg = strMsg & "<td width='70'>&nbsp;</td>"
    strMsg = strMsg & "<td width='78'>&nbsp;</td>"
    strMsg = strMsg & "<td width='50' rowspan='6'>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td class='main2'>Address:</td>"
    strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Address1")&"</td><td>&nbsp;</td><td>&nbsp;</td><td>&nbsp;</td> <td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td class='main2'>Address 2:</td>"
    strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Address2")&"</td>"
    strMsg = strMsg & "<td>&nbsp;</td><td width='70'>&nbsp;</td><td width='70'>&nbsp;</td><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td class='main2'>City:</td>"
    strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_City")&"</td>"
    strMsg = strMsg & "<td class='main2'>State:</td>"
    strMsg = strMsg & "<td>"&REQUEST("CON_Main_State")&"</td>"
    strMsg = strMsg & "<td class='main2' width='70'>Zip:</td>"
    strMsg = strMsg & "<td>"&REQUEST("CON_Main_Zip")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td height='35' class='main2'>Home Phone:</td>"
    strMsg = strMsg & "<td width='150'>"&REQUEST("CON_Main_Tel")&"</td>"
    strMsg = strMsg & "<td class='main2' width='90'> Work Phone:</td>"
    strMsg = strMsg & "<td>"&REQUEST("CON_Work_Phone")&"</td>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr valign='top'> "
    strMsg = strMsg & "<td class='main2'>Date of Birth: </td>"
    strMsg = strMsg & "<td width='150'><table width='100%' border='0' cellspacing='0' cellpadding='0'>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td width='30%'>"&REQUEST("CON_Birth_Date")&"/"&REQUEST("CON_Birth_Month")&"/"&REQUEST("CON_Birth_Year")&"</td>"
    strMsg = strMsg & "</tr></table></td><td>&nbsp;</td><td>&nbsp;</td>"
    strMsg = strMsg & "<td>&nbsp;</td><td>&nbsp;</td></tr> </table></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> <td class='main'>Drugs Taken:</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td><table width='75%' border='0' cellspacing='0' cellpadding='0'>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td width='2%'><input type='checkbox' name='Pondimin'"
    IF REQUEST("Pondimin") = "yes" tHEN
    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & "></td>"
    strMsg = strMsg & "<td class='main2' width='48%'><b>Pondimin (Fenfluramine)</b></td>"
    strMsg = strMsg & "<td width='2%'><input type='checkbox' name='Redux' value='yes'"

    IF REQUEST("Redux") = "yes" THEN

    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & "></td>"
    strMsg = strMsg & "<td class='main2' width='48%'><b>Redux (Dexfenfluramine)</b></td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "</table></td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> <td><span class='main2'>From:</span>"&REQUEST("from")
    strMsg = strMsg & "<span class='main2'> To:</span>"&REQUEST("to")
    strMsg = strMsg & "<span style='font-family:Wingdings;'>"
    strMsg = strMsg & "<input type='radio' name='less' value='0'"

    IF REQUEST("less") = 0 THEN
    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & "></span> <span class='main2'>60 days or less </span> <span style='font-family:Wingdings;'>"
    strMsg = strMsg & "<input type='radio' name='less' value='1' "
    IF REQUEST("less") = 1 THEN

    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & "></span><span class='main2'>61 days or more</span></td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> <td><span class='main2'>Prescribed by: </span>"&REQUEST("prescribed")
    strMsg = strMsg & "<span class='main2'>Dispensed by:</span><u>"&REQUEST("dispenced")
    strMsg = strMsg & "</u></td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr><td><u class='main'>Echocardiogram</u></td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr><td class='main2'>Please supply copies of all echocardiograms</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr valign='top'>"
    strMsg = strMsg & "<td><table width='75%' border='0' cellpadding='0' cellspacing='0' class='main2'>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td width='29%' class='main2'>Echo Date</td>"
    strMsg = strMsg & "<td width='71%'><table width='35%' border='0' cellspacing='0' cellpadding='0'><tr>"
    strMsg = strMsg & "<td width='30%'>"&REQUEST("Echo_Date")&"/"&REQUEST("Echo_Month")&"/"&REQUEST("Echo_Year")&"</td>"
    strMsg = strMsg & "</tr></table></td></tr><tr> <td>&nbsp;</td><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr><td>Cardiologist</td>"
    strMsg = strMsg & "<td>"&REQUEST("Cardiologist")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td>Level</td>"
    strMsg = strMsg & "<td>"&REQUEST("level")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>Level of Mitrovalve Regurgitation (RJA/LAA)</td>"
    strMsg = strMsg & "<td>"&REQUEST("Mitrovalve_Regurgitation")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr><td>Level of Aortic Regurgitation (RJH/VOT</td>"
    strMsg = strMsg & "<td>"&REQUEST("Regurgitation") &"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td>Complications</td>"
    strMsg = strMsg & "<td>"&REQUEST("Complications")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "</table></td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td class='main2'><b>Were there any pre-existing conditions?</b></td></tr>"
    strMsg = strMsg & "<tr valign='top'> "
    strMsg = strMsg & "<td>"&REQUEST("conditions")&"</td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr><tr>"
    strMsg = strMsg & "<td><u class='main'>Attorney</u></td></tr>"
    strMsg = strMsg & "<tr><td><span class='main2'>Is this case taken on a contingency basis:</span><span class='main2'>Yes</span> <span class='main2'>"&REQUEST("contingency_yes")
    strMsg = strMsg & "% &nbsp;</span><span class='main2'>No</span><span class='main2'>"&REQUEST("contingency_no")
    strMsg = strMsg & "&nbsp;</span><b><u class='main2'>Costs to Date:<span class='main2'>"&REQUEST("costs")
    strMsg = strMsg & "</span></u></b></td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td><span class='main2'>Case Preparation $<span class='main2'>"&REQUEST("case1")
    strMsg = strMsg & "</span>Future $ "&REQUEST("future1")
    strMsg = strMsg & "<u> </u></span><u></u></td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr><td><span class='main2'>Lost Client Income: $ "&REQUEST("lost")
    strMsg = strMsg & "<u> </u> Future </span><span class='main2'> </span><span class='main2'>$ "&REQUEST("future2")
    strMsg = strMsg & "<u> </u></span></td></tr>"
    strMsg = strMsg & "<tr> <td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> <td><span class='main2'>Medical $ "&REQUEST("medical")
    strMsg = strMsg & "<u></u> Future $ "&REQUEST("future3")
    strMsg = strMsg & "<u></u></span><u></u></td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr><tr> "
    strMsg = strMsg & "<td><span class='main2'>Have any settlement offers (verbal / written) been made: $ "&REQUEST("money")
    strMsg = strMsg & "</span><u> </u></td></tr>"
    strMsg = strMsg & "<tr><td class='main2'>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> "
    strMsg = strMsg & "<td class='main2'>Will Clients Settlement Check Be Deposited Into Your Trust Account? <span style='font-family:Wingdings;'> <span style='font-family:Wingdings;'> <input type='radio' name='Settlement' value='Yes'"
    IF REQUEST("Settlement") = "Yes" THEN
    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & "></span></span> Yes <span style='font-family:Wingdings;'><input type='radio' name='Settlement' value='No'"

    IF REQUEST("Settlement") = "No" THEN
    strMsg = strMsg & " Checked"
    END IF
    strMsg = strMsg & " ></span> No</td></tr>"
    strMsg = strMsg & "<tr><td>&nbsp;</td></tr>"
    strMsg = strMsg & "<tr> <td><span class='main2'>What is <b><u>your estimated</u></b> Matrix Value of this case? </span><span class='main2'></span><span class='main2'>$ "&REQUEST("Matrix")
    strMsg = strMsg & "</span><u></u></td></tr><tr><td class='main2'>&nbsp;</td></tr><tr> "
    strMsg = strMsg & "<td class='main2'>What is<b><u> your estimated</u></b> Opt-Out Value of this case? $<span class='main2'>"&REQUEST("Opt-Out") &"</span></td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>&nbsp;</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr><td><span class='main2'><b><i><u>Please note that this will not be revealed to anyone including your client and that we understand that you are offering no proffers of guaranty or opinion as it pertains to the viability of this case.</u></i></b></span><b><i><u></u></i></b></td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "<tr> <td>&nbsp;</td>"
    strMsg = strMsg & "</tr><tr> <td class='main2'>Why Wouldn't This Case Settle?</td></tr><tr valign='top'><td>"&REQUEST("why")&"</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>Authorization:</td></tr>"
    strMsg = strMsg & "<tr>"
    strMsg = strMsg & "<td>"&REQUEST("Authorization")&"</td>"
    strMsg = strMsg & "</tr>"
    strMsg = strMsg & "</table></form>"

    'response.write strMsg

    strSubject = "Fen-Phen Application"
    SET objMyCDONTSMail = CREATEOBJECT("CDONTS.NewMail")
    objMyCDONTSMail.BodyFormat = 0
    objMyCDONTSMail.MailFormat = 0
    objMyCDONTSMail.Send "ap1@captran.com",strSubject,strMsg
    SET objMyCDONTSMail = NOTHING


    %>

  • #2
    Senior Coder
    Join Date
    Dec 2002
    Location
    Arlington, Texas USA
    Posts
    1,062
    Thanks
    4
    Thanked 8 Times in 8 Posts

    show us the sending form

    show us the page that has the form on it.

  • #3
    New to the CF scene
    Join Date
    Aug 2004
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    Code to Long

    The code is to long. I cant post it. Can I e-mail it to you?

  • #4
    Senior Coder
    Join Date
    Dec 2002
    Location
    Arlington, Texas USA
    Posts
    1,062
    Thanks
    4
    Thanked 8 Times in 8 Posts
    attach the file to a message here or point us to the url and we can view the source code

  • #5
    New to the CF scene
    Join Date
    Aug 2004
    Posts
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    Thanked 0 Times in 0 Posts

    Arrow Code for the form

    Here is a link to the code for the form itself. Thanks in advance for all the help.... http://www.mckenziecreations.net/fenphen.htm


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