A & O Pharmacy

<%@LANGUAGE="JAVASCRIPT"%> <% CDOMail = Server.CreateObject("CDONTS.NewMail"); CDOMail.From = Request("email"); CDOMail.To = "info@aopharmacy.com"; CDOMail.Subject = "Online Refill Requests Form"; CDOMail.Body = "First Name: " + String(Request("first_name")) + "\r\n\r\n" + "Last Name: " + String(Request("last_name")) + "\r\n\r\n" + "Phone Number: " + String(Request("phone")) + "\r\n\r\n" + "Email: " + String(Request("email")) + "\r\n\r\n" + "Mailing Address: " + String(Request("address")) + "\r\n\r\n" + "City: " + String(Request("city")) + "\r\n\r\n" + "State: " + String(Request("state")) + "\r\n\r\n" + "Zip Code: " + String(Request("zip")) + "\r\n\r\n" + "First Refill Number: " + String(Request("refill_number1")) + "\r\n\r\n" + "Second Refill Number: " + String(Request("refill_number2")) + "\r\n\r\n" + "Third Refill Number: " + String(Request("refill_number3")) + "\r\n\r\n" + "Fourth Refill Number: " + String(Request("refill_number4")) + "\r\n\r\n" + "Fifth Refill Number: " + String(Request("refill_number5")) + "\r\n\r\n" + "Comments or Special Requests: " + String(Request("comments")) + "\r\n\r\n" CDOMail.Send(); %> A & O Pharmacy