<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Session.LCID = 1033 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("print order form_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(45) Dim arFormDBFields0(45) Dim arFormValues0(45) arFormFields0(0) = "order_state" arFormDBFields0(0) = "order_state" arFormValues0(0) = Request("order_state") arFormFields0(1) = "ship_mid_initial" arFormDBFields0(1) = "ship_mid_initial" arFormValues0(1) = Request("ship_mid_initial") arFormFields0(2) = "ship_zip_code" arFormDBFields0(2) = "ship_zip_code" arFormValues0(2) = Request("ship_zip_code") arFormFields0(3) = "price_tax" arFormDBFields0(3) = "price_tax" arFormValues0(3) = Request("price_tax") arFormFields0(4) = "payment_visa" arFormDBFields0(4) = "payment_visa" arFormValues0(4) = Request("payment_visa") arFormFields0(5) = "payment_cc_number" arFormDBFields0(5) = "payment_cc_number" arFormValues0(5) = Request("payment_cc_number") arFormFields0(6) = "oder_add_items" arFormDBFields0(6) = "oder_add_items" arFormValues0(6) = Request("oder_add_items") arFormFields0(7) = "order_first_name" arFormDBFields0(7) = "order_first_name" arFormValues0(7) = Request("order_first_name") arFormFields0(8) = "ship_last_name" arFormDBFields0(8) = "ship_last_name" arFormValues0(8) = Request("ship_last_name") arFormFields0(9) = "payment_gift_cert" arFormDBFields0(9) = "payment_gift_cert" arFormValues0(9) = Request("payment_gift_cert") arFormFields0(10) = "price_grand_tot" arFormDBFields0(10) = "price_grand_tot" arFormValues0(10) = Request("price_grand_tot") arFormFields0(11) = "order_address1" arFormDBFields0(11) = "order_address1" arFormValues0(11) = Request("order_address1") arFormFields0(12) = "payment_bill" arFormDBFields0(12) = "payment_bill" arFormValues0(12) = Request("payment_bill") arFormFields0(13) = "price_ship_cost" arFormDBFields0(13) = "price_ship_cost" arFormValues0(13) = Request("price_ship_cost") arFormFields0(14) = "order_address2" arFormDBFields0(14) = "order_address2" arFormValues0(14) = Request("order_address2") arFormFields0(15) = "order_add_price" arFormDBFields0(15) = "order_add_price" arFormValues0(15) = Request("order_add_price") arFormFields0(16) = "order_name_suffix" arFormDBFields0(16) = "order_name_suffix" arFormValues0(16) = Request("order_name_suffix") arFormFields0(17) = "order_daytime_phone" arFormDBFields0(17) = "order_daytime_phone" arFormValues0(17) = Request("order_daytime_phone") arFormFields0(18) = "oder_zip_code" arFormDBFields0(18) = "oder_zip_code" arFormValues0(18) = Request("oder_zip_code") arFormFields0(19) = "order_price" arFormDBFields0(19) = "order_price" arFormValues0(19) = Request("order_price") arFormFields0(20) = "order_message" arFormDBFields0(20) = "order_message" arFormValues0(20) = Request("order_message") arFormFields0(21) = "price_ship_method" arFormDBFields0(21) = "price_ship_method" arFormValues0(21) = Request("price_ship_method") arFormFields0(22) = "order_home_phone" arFormDBFields0(22) = "order_home_phone" arFormValues0(22) = Request("order_home_phone") arFormFields0(23) = "ship_name_suffix" arFormDBFields0(23) = "ship_name_suffix" arFormValues0(23) = Request("ship_name_suffix") arFormFields0(24) = "payment_mc" arFormDBFields0(24) = "payment_mc" arFormValues0(24) = Request("payment_mc") arFormFields0(25) = "order_last_name" arFormDBFields0(25) = "order_last_name" arFormValues0(25) = Request("order_last_name") arFormFields0(26) = "order_zip4" arFormDBFields0(26) = "order_zip4" arFormValues0(26) = Request("order_zip4") arFormFields0(27) = "ship_phone" arFormDBFields0(27) = "ship_phone" arFormValues0(27) = Request("ship_phone") arFormFields0(28) = "date_ordered" arFormDBFields0(28) = "date_ordered" arFormValues0(28) = Request("date_ordered") arFormFields0(29) = "payment_chk_mo" arFormDBFields0(29) = "payment_chk_mo" arFormValues0(29) = Request("payment_chk_mo") arFormFields0(30) = "price_basket_tot" arFormDBFields0(30) = "price_basket_tot" arFormValues0(30) = Request("price_basket_tot") arFormFields0(31) = "Payment_cc_exp_yr" arFormDBFields0(31) = "Payment_cc_exp_yr" arFormValues0(31) = Request("Payment_cc_exp_yr") arFormFields0(32) = "order_from" arFormDBFields0(32) = "order_from" arFormValues0(32) = Request("order_from") arFormFields0(33) = "order_city" arFormDBFields0(33) = "order_city" arFormValues0(33) = Request("order_city") arFormFields0(34) = "ship_first_name" arFormDBFields0(34) = "ship_first_name" arFormValues0(34) = Request("ship_first_name") arFormFields0(35) = "ship_city" arFormDBFields0(35) = "ship_city" arFormValues0(35) = Request("ship_city") arFormFields0(36) = "ship_zip" arFormDBFields0(36) = "ship_zip" arFormValues0(36) = Request("ship_zip") arFormFields0(37) = "payment_cc_exp" arFormDBFields0(37) = "payment_cc_exp" arFormValues0(37) = Request("payment_cc_exp") arFormFields0(38) = "delivery_time" arFormDBFields0(38) = "delivery_time" arFormValues0(38) = Request("delivery_time") arFormFields0(39) = "D1" arFormDBFields0(39) = "D1" arFormValues0(39) = Request("D1") arFormFields0(40) = "ship_state" arFormDBFields0(40) = "ship_state" arFormValues0(40) = Request("ship_state") arFormFields0(41) = "delivery_date" arFormDBFields0(41) = "delivery_date" arFormValues0(41) = Request("delivery_date") arFormFields0(42) = "order_mid_initial" arFormDBFields0(42) = "order_mid_initial" arFormValues0(42) = Request("order_mid_initial") arFormFields0(43) = "ship_address" arFormDBFields0(43) = "ship_address1" arFormValues0(43) = Request("ship_address") arFormFields0(44) = "order_item_num" arFormDBFields0(44) = "order_item_num" arFormValues0(44) = Request("order_item_num") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name" End If If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "print%20order%20form.htm",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Gift Basket Creations Order Form

 

Order Form

Please allow 48 hours notice when ordering gift baskets

Set page orientation to Landscape before printing

140 North Main Street, Mountain Top, PA 18707  

Phone:   (800) 894-8211          or        (570) 474-0180      

Fax: (570) 474-2920

 

Date Ordered: (mm/dd/yyyy)   Date to be Delivered: (mm/dd/yyyy)   Time to be Delivered:

Ordered By: First Name     Middle Initial     Last Name     Suffix

Address 1                  Home Phone (area code) xxx-xxxx

Address 2                  Daytime Phone (area code) xxx-xxxx

City                   State         Zip Code -

Ship To: First Name     Middle Initial     Last Name     Suffix

Address 1                   Phone (area code) xxx-xxxx

Address 2                             

City                   State         Zip Code -

 

Method of Payment: Check or Money Order    Gift Basket Creations Gift Certificate    Mail Bill

 Visa    Master Card    American Express    Card Number:     Exp. Date /

Order:  Item / Basket Number         Price $

Additional Items to Basket or Special Package

Price for additional items $                                                  Message

 

                           From       

 

Total Basket Price $        Shipping Method         Shipping Cost $            Tax $          

Total Order Cost $

 

140 N. Main St., Mountain Top, PA 18707
570-474-0180                1-800-894-8211
E-Mail:                info@giftbasketcreations.com