Home

Place an Order

Your Account

About Us

Help

<% dim gCompanyName, gContactName, gAddress, gCity, gState, gZip, gPhone, gFax, gCompanyWebsite, gTypeOfBusiness dim gAvgDelivery dim gBillingName, gBillingAddress, gBillingCity, gBillingState, gBillingZip, gBillingPhone, gBillingFax dim gBillingContactName, gBillingContactTitle, gBillingContactPhone, gBillingContactEmail dim gAccountContactName, gAccountContactTitle, gAccountContactPhone, gAccountContactEmail dim gFreightCompanyHandling, gFreightCompany, gPickDelivery1, gPickDelivery2, gPickDelivery3, gPickDelivery4 dim gBriefDescription, gSpecialInstructions, gHearAboutUs, gCreditReferences, gSignature, gDate dim mail, sMsg gCompanyName = Request.Form("CompanyName") if gCompanyName <> "" then gContactName = Request.Form("ContactName") gAddress = Request.Form("Address") gCity = Request.Form("City") gState = Request.Form("State") gZip = Request.Form("Zip") gPhone = Request.Form("Phone") gFax = Request.Form("Fax") gCompanyWebsite = Request.Form("CompanyWebsite") gTypeOfBusiness = Request.Form("TypeOfBusiness") gAvgDelivery = Request.Form("AvgDelivery") gBillingName = Request.Form("BillingName") gBillingAddress = Request.Form("BillingAddress") gBillingCity = Request.Form("BillingCity") gBillingState = Request.Form("BillingState") gBillingZip = Request.Form("BillingZip") gBillingPhone = Request.Form("BillingPhone") gBillingFax = Request.Form("BillingFax") gBillingContacName = Request.Form("BillingContactName") gBillingContactTitle = Request.Form("BillingContactTitle") gBillingContactPhone = Request.Form("BillingContactPhone") gBillingContactEmail = Request.Form("BillingContactEmail") gAccountContactName = Request.Form("AccountContactName") gAccountContactTitle = Request.Form("AccountContactTitle") gAccountContactPhone = Request.Form("AccountContactPhone") gAccountContactEmail = Request.Form("AccountContactEmail") gFreightCompanyHandling = Request.Form("FreightCompanyHandling") gFreightCompany = Request.Form("FreightCompany") gPickDelivery1 = Request.Form("PickDelivery1") gPickDelivery2 = Request.Form("PickDelivery2") gPickDelivery3 = Request.Form("PickDelivery3") gPickDelivery4 = Request.Form("PickDelivery4") gBriefDescription = Request.Form("BriefDescription") gSpecialInstructions = Request.Form("SpecialInstructions") gHearAboutUs = Request.Form("HearAboutUs") gCreditReferences = Request.Form("CreditReferences") gSignature = Request.Form("Signature") gDate = Request.Form("Date") set mail = Server.CreateObject("CDONTS.NewMail") mail.To = "[email protected]" mail.From = "[email protected]" mail.Subject = "Open a New Account" sMsg = "Company Name: " & gCompanyName & Chr(13) sMsg = sMsg & "Contact Name: " & gContactName & Chr(13) sMsg = sMsg & "Address: " & gAddress & Chr(13) sMsg = sMsg & "City: " & gCity & Chr(13) sMsg = sMsg & "State: " & gState & Chr(13) sMsg = sMsg & "Zip: " & gZip & Chr(13) sMsg = sMsg & "Phone: " & gPhone & Chr(13) sMsg = sMsg & "Fax: " & gFax & Chr(13) sMsg = sMsg & "Company Website: " & gCompanyWebsite & Chr(13) sMsg = sMsg & "Type of Business: " & gTypeOfBusiness & Chr(13) sMsg = sMsg & "Avg. Delivery: " & gAvgDelivery & Chr(13) sMsg = sMsg & "Billing Name: " & gBillingName & Chr(13) sMsg = sMsg & "Billing Address: " & gBillingAddress & Chr(13) sMsg = sMsg & "Billing City: " & gBillingCity & Chr(13) sMsg = sMsg & "Billing State: " & gBillingState & Chr(13) sMsg = sMsg & "Billing Zip: " & gBillingZip & Chr(13) sMsg = sMsg & "Billing Phone: " & gBillingPhone & Chr(13) sMsg = sMsg & "Billing Fax: " & gBillingFax & Chr(13) sMsg = sMsg & "Billing Contact Name: " & gBillingContactName & Chr(13) sMsg = sMsg & "Billing Contact Title: " & gBillingContactTitle & Chr(13) sMsg = sMsg & "Billing Contact Phone: " & gBillingContactPhone & Chr(13) sMsg = sMsg & "Billing Contact Email: " & gBillingContactEmail & Chr(13) sMsg = sMsg & "Account Contact Name: " & gAccountContactName & Chr(13) sMsg = sMsg & "Account Contact Title: " & gAccountContactTitle & Chr(13) sMsg = sMsg & "Account Contact Phone: " & gAccountContactPhone & Chr(13) sMsg = sMsg & "Account Contact Email: " & gAccountContactEmail & Chr(13) sMsg = sMsg & "Freight handling company: " & gFreightCompanyHandling & Chr(13) sMsg = sMsg & "Freight handling company's name: " & gFreightCompany & Chr(13) & Chr(13) sMsg = sMsg & "Pickup/Delivery 1: " & gPickDelivery1 & Chr(13) sMsg = sMsg & "Pickup/Delivery 2: " & gPickDelivery2 & Chr(13) sMsg = sMsg & "Pickup/Delivery 3: " & gPickDelivery3 & Chr(13) sMsg = sMsg & "Pickup/Delivery 4: " & gPickDelivery4 & Chr(13) sMsg = sMsg & "Brief Description: " & gBriefDescription & Chr(13) & Chr(13) sMsg = sMsg & "Special Instruction: " & gSpecialInstructions & Chr(13) & Chr(13) sMsg = sMsg & "Hear about us: " & gHearAboutUs & Chr(13) & Chr(13) sMsg = sMsg & "Credit References: " & gCreditReferences & Chr(13) sMsg = sMsg & "Signature: " & gSignature & Chr(13) sMsg = sMsg & "Date: " & gDate & Chr(13) mail.Body = sMsg 'Response.Write sMsg mail.Send %> <% else ShowContactForm end if sub ShowContactForm %>

New Account Applicaton

Company Name:
Contact Name:
Address:
City:		State:
Zip:
Phone:		Fax:
Company Web Site:
Type of Business:
# of deliveries per month:
Billing Name:
Billing Address:
Billing City:		State:
Billing Zip:
Billing Phone:		Fax:

Contacts
Billing Contact Name:
Title:
Phone:		Email:

Account Contact Name:
Title:
Phone:		Email:

Other
Does a freight company handle your billing? yes no
If so, which company?
Please provide a list of common pickup/delivery locations that you frequently ship to or from:




Please provide a brief description of a reference to assign to each order (to appear on your invoice, i.e., department number, cost center number, job number, reference number, etc.)
Special Instructions (to communicate to dispatch or customer service):
How did you hear about us?
Please provide three credit references:
By submitting this form, I acknowledge that I have read and received a copy of the Terms and Conditions for service usage, and I agree to be bound by them.

<% end sub %>