<% Dim landing_page, host_url Dim fso, outfile, filename, dirname, myFolder Dim req_method, key, value Dim bErr, errStr, bEmpty On Error resume next bErr = false bEmpty = true errStr = "" Set fso = Server.CreateObject("Scripting.FileSystemObject") host_url = Request.ServerVariables("HTTP_HOST") req_method = Request.ServerVariables("REQUEST_METHOD") dtNow = Now() filename = Server.MapPath("ssfm") dirname = filename filename = filename & "/gdform_" & DatePart("M", dtNow) & DatePart("D", dtNow) & DatePart("YYYY", dtNow) & DatePart("N", dtNow) & DatePart("S", dtNow) Function FormatVariableLine(byval var_name, byVal var_value) Dim tmpStr tmpStr = tmpStr & "" & vbCRLF tmpStr = tmpStr & var_value & vbCRLF tmpStr = tmpStr & "" FormatVariableLine = tmpStr end function Sub OutputLine(byVal line) outfile.WriteLine(line) end sub if err.number = 0 then Set outfile = fso.CreateTextFile(filename, true, false) if err.number <> 0 then bErr = true errStr = "Error creating file! Directory may not be writable or may not exist.
Unable to process request." else if(req_method = "GET") then for each Item in request.QueryString if item <> "" then bEmpty = false key = item value = Request.QueryString(item) if(lcase(key) = "redirect") then landing_page = value else line = FormatVariableLine(key, value) Call OutputLine(line) end if end if next elseif (req_method = "POST") then for each Item in request.form if item <> "" then bEmpty = false key = item value = Request.form(item) if(lcase(key) = "redirect") then landing_page = value else line = FormatVariableLine(key, value) Call OutputLine(line) end if end if next end if outfile.close end if if(bEmpty = true) AND errStr = "" then bErr = true errStr = errStr & "
No variables sent to form! Unable to process request." end if if(bErr = false) then if (landing_page <> "") then response.Redirect "http://" & host_url & "/" & landing_page else response.Redirect "http://" & host_url end if else Response.Write errStr end if set fso = nothing else Response.Write " An Error Occurred creating mail message. Unable to process form request at this time." end if %>

Putt Poker™ - Wholesale Registration Form

Required Fields Denoted with an: *

We will contact you by phone for payment information. We accept Visa, Mastercard, American Express and Discover.

Please Fill out the form below and click 'submit registration'.


*COMPANY NAME:

  
 
*TYPE OF BUSINESS:
  
*FIRST NAME:
  
 
*LAST NAME:
  
 
*TITLE:
  
*ADDRESS 1:
  
 
*ADDRESS 2:
  
*CITY:
  
 
*STATE:
  
 
*ZIP:
  
 
*COUNTRY:
  
 
ENTER THE SHIPPING ADDRESS INFORMATION
IF IT IS DIFFERENT FROM YOUR BILLING ADDRESS
SHIPPING ADDRESS 1:
  
SHIPPING ADDRESS 2:
  
SHIPPING CITY:
  
SHIPPING STATE:
  
SHIPPING ZIP:
  
SHIPPING COUNTRY:
  

*TAX ID NUMBER:

  

 

*STATE ISSUED:

*QUANTITY (min. 9)

 

 
*PHONE:
  
 
*FAX:
  
*EMAIL ADDRESS:
  
 
*WEB SITE:
  

ADDITIONAL COMMENTS OR INFORMATION: