<% if request.form("submit") <> "" then set conn = server.createobject("adodb.connection") conn.open "PROVIDER=MICROSOFT.JET.OLEDB.4.0;DATA SOURCE=" & server.mappath("../db1.mdb") sql = "insert into tblPetroOrders(firstname,lastname,address,city,state,zip,homephone,workphone,email,comments,kerosene,oil,diesel,gasoline,orderdate,ip) values(" sql = sql & "'" & request.form("firstname") & "'," sql = sql & "'" & request.form("lastname") & "'," sql = sql & "'" & request.form("address") & "'," sql = sql & "'" & request.form("city") & "'," sql = sql & "'" & request.form("state") & "'," sql = sql & "'" & request.form("zip") & "'," sql = sql & "'" & request.form("homephone") & "'," sql = sql & "'" & request.form("workphone") & "'," sql = sql & "'" & request.form("email") & "'," sql = sql & "'" & request.form("comments") & "'," sql = sql & "'" & request.form("kerosene") & "'," sql = sql & "'" & request.form("oil") & "'," sql = sql & "'" & request.form("diesel") & "'," sql = sql & "'" & request.form("gasoline") & "'," sql = sql & "'" & date() & "'," sql = sql & "'" & request.servervariables("remote_host") & "')" msg = "Thank you!!! We will get back with you soon." conn.execute sql conn.close end if %> Petroleum
 


<%=msg%>

Please fill the form below and let us know your specific requirements. 

First Name*:   Last name*:  
Address*:    City*:  
State*:    Zip*:  
Home#*:   Work#*:  
email:  
 
Product Qty.(gallons)
1. Kerosene
2. Fuel Oil
3. Diesel Fuel
4. Gasoline
 
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