<% Submit = Replace(Request("Submit"),"'","''") if Submit="Submit" then Set Mail = Server.CreateObject("Persits.MailSender") Mail.Host = "" Mail.From= "formhandler@vusafe.com" Mail.FromName = "VuSafe.com" Mail.AddAddress "formhandler@vusafe.com", "VuSafe" Mail.Subject = "Authorized Installer Registration" strMsgHeader = "Form information follows" & vbCrLf for each qryItem in Request.Form if qryItem <> "Submit" then strMsgInfo = strMsgInfo & qryItem & ": " & request.Form(qryItem) & vbCrLf end if next strMsgFooter = vbCrLf & "End of form information" Mail.Body = strMsgInfo 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 if bSuccess then %>

Thank you for your inquiry. A customer service representative will contact you shortly.

<% else Response.Write "Mail send failure. Error was " & Mailer.Response end if else %>

Authorized Installer Registration

Registration to become an authorized installer is open to contractors, caretakers and facilities managers. Simply fill out the form below and one of our account managers will contact you within 2 business days to continue the registration process.

First Name: (required)
Last Name: (required)
Company Name:
State:   ZIP:
Email: (required)
Phone: Please use the most convenient to contact you with.
Years in business?
Type of company:
Business Type:
Memberships / Licenses:
<% end if set Mail = Nothing %>


      Authorized Installer Registration Form
      Interview with a
      VuSafe Account Manager