John J. Boyd & Associates, Inc. - Request an Individual Insurance Quote

<% dim objSecure dim objConn dim objRS dim strSQL dim strSiteTitle dim strSiteDomain dim objMailer dim strGroupQuoteEmail dim strCmd dim strBody dim intA dim arrEmailAddress dim strName dim strGender dim strAddress dim strZip dim strPhone dim strEmail dim strApplicantDOB dim strSpouseDOB dim strChild1DOB dim strChild2DOB dim strChild3DOB dim strChild4DOB dim strCurrentCarrier dim strKnownConditions dim strSpecialRequests set objSecure = server.createobject("inetsolution.secure") set objConn = objSecure.Conn set objRS = Server.CreateObject("ADODB.Recordset") strSQL = "select INDQUOTEEMAIL, SITETITLE,SITEDOMAIN,CONTACTEMAIL from SITEPARAMS" objRS.Open strSQL, objConn, adOpenDynamic, adLockOptimistic, adCmdText strSiteTitle = trim(objRS("SITETITLE")) strSiteDomain = trim(objRS("SITEDOMAIN")) strCmd = trim(request.form("cmd")) select case strCmd case "send" strName = trim(request.form("name")) strGender = trim(request.form("gender")) strAddress = trim(request.form("address")) strZip = trim(request.form("zip")) strPhone = trim(request.form("phone")) strEmail = trim(request.form("email")) strApplicantDOB = trim(request.form("applicantDOB")) strSpouseDOB = trim(request.form("spouseDOB")) strChild1DOB = trim(request.form("child1DOB")) strChild2DOB = trim(request.form("child2DOB")) strChild3DOB = trim(request.form("child3DOB")) strChild4DOB = trim(request.form("child4DOB")) strCurrentCarrier = trim(request.form("currentCarrier")) strKnownConditions = trim(request.form("knownConditions")) strSpecialRequests = trim(request.form("specialRequests")) strBody = "Date Posted: " & now() & vbCrLf & vbCrLf strBody = strBody & "Contact Information" & vbCrLf & "----------------------" & vbCrLf if strName <> "" then strBody = strBody & "Name: " & strName & vbCrLf end if if strGender <> "" then strBody = strBody & "Gender: " & strGender & vbCrLf end if if strAddress <> "" then strBody = strBody & "Address: " & strAddress & vbCrLf end if if strZip <> "" then strBody = strBody & "Zip: " & strZip & vbCrLf end if if strPhone <> "" then strBody = strBody & "Phone: " & strPhone & vbCrLf end if if strEmail <> "" then strBody = strBody & "Email: " & strEmail & vbCrLf end if strBody = strBody & vbCrLf & "Those Covered" & vbCrLf & "----------------------" & vbCrLf & vbCrLf if strApplicantDOB <> "" then strBody = strBody & "Applicant DOB: " & strApplicantDOB & vbCrLf end if if strSpouseDOB <> "" then strBody = strBody & "Spouse DOB: " & strSpouseDOB & vbCrLf end if if strChild1DOB <> "" then strBody = strBody & "Child 1 DOB: " & strChild1DOB & vbCrLf end if if strChild2DOB <> "" then strBody = strBody & "Child 2 DOB: " & strChild2DOB & vbCrLf end if if strChild3DOB <> "" then strBody = strBody & "Child 3 DOB: " & strChild3DOB & vbCrLf end if if strChild4DOB <> "" then strBody = strBody & "Child 4 DOB: " & strChild4DOB & vbCrLf end if strBody = strBody & vbCrLf & "Coverage" & vbCrLf & "----------------------" & vbCrLf if strCurrentCarrier <> "" then strBody = strBody & "Current Carrier: " & strCurrentCarrier & vbCrLf end if if strKnownConditions <> "" then strBody = strBody & "Known Conditions: " & strKnownConditions & vbCrLf end if if strSpecialRequests <> "" then strBody = strBody & "Special Requests: " & strSpecialRequests & vbCrLf end if strBody = strBody & vbCrLf & vbCrLf & "-----------------" & vbCrLf & "End Message" Set objMailer = Server.CreateObject("SMTPsvg.Mailer") objMailer.FromName = strSiteTitle & " InetActive" objMailer.FromAddress= "webmaster@" & strSiteDomain objMailer.RemoteHost = "relay.inetsolution.com;smtp.inetsolution.com" on error resume next arrEmailAddress = split(trim(objSecure.Conn.execute("select INDQUOTEEMAIL from SITEPARAMS")(0)),",") on error goto 0 if isarray(arrEmailAddress) then for intA = 0 to ubound(arrEmailAddress) objMailer.AddRecipient "John J. Boyd & Associates", arrEmailAddress(intA) next 'intA else objMailer.AddRecipient "John J. Boyd & Associates Health Insurance Form issue(email problem)","webmaster@inetsolution.com" end if objRS.Close set objRS = nothing objConn.Close objMailer.Subject = strSiteTitle & " Health Insurance Form" objMailer.BodyText = strBody if objMailer.sendMail then if strEmail <> "" then 'Send auto responder text to the user strBody = "" objMailer.ClearRecipients objMailer.ClearBodyText strBody = strName & "," & vbCrLf & vbCrLf strBody = strBody & "Thank you for contacting John J. Boyd & Associates. We will respond to your inquiry " strBody = strBody & "within two business days. If you would like immediate assistance, you may call us at (586) 314-3400. We appreciate the opportunity to serve you." & vbCrLf strBody = strBody & vbCrlF & vbCrLf & "Sincerly," & vbCrLf & "John J. Boyd & Associates" & vbCrLf objMailer.FromName = strSiteTitle objMailer.FromAddress= "webmaster@" & strSiteDomain objMailer.RemoteHost = "relay.inetsolution.com" objMailer.AddRecipient strName, strEmail objMailer.Subject = strSiteTitle & " John J. Boyd & Associates Contact" objMailer.BodyText = strBody objMailer.SendMail end if response.redirect("submission-success.asp") else response.redirect("individual-health-insurance-form.asp?r=f") end if set objMailer = Nothing case else 'Just let the page load end select %> John J. Boyd & Associates, Inc. - Request an Individual Insurance Quote

FAQ/Q&A | What's New | Our Newsletter

Request individual insurance quote

Need some help?

If you require assistance completing this form, a member of our staff will be happy to assist you.

John J. Boyd and Associates, Inc.
45174 Cass Avenue
Utica, MI 48317

586-314-3400 (Phone)
586-314-3405 (Fax)