<form action="<%=Request.ServerVariables("SCRIPT_NAME")%>" method="post">
<table border="0" width="570" align="center" cellpadding="1" cellspacing="0">
<tr>
<td align="right" valign="center"><%=font4%><font color="#ff0000">* </font>First Name: </td>
<td align="left" valign="top"><input name="first" size="25" maxlength="50" tabindex="1"></td>
</tr>
<tr>
<td align="right"><%=font4%><font color="#ff0000">* </font>Last Name: </font></td>
<td align="left"><input name="last" size="25" maxlength="50" tabindex="2"></td>
</tr>
<tr>
<td align="right"><%=font4%>Company Name: </font></td>
<td align="left"><input name="company" size="25" maxlength="100" tabindex="3"></td>
</tr>
<tr>
<td align="right"><%=font4%><font color="#ff0000">* </font>E-Mail Address: </font></td>
<td align="left"><input name="email" size="25" maxlength="100" tabindex="4"></td>
</tr>
<tr>
<td align="right"><%=font4%> Phone: </font></td>
<td align="left"><input name="phone" size="25" maxlength="20" tabindex="5"></td>
</tr>
<tr>
<td align="right"><%=font4%> Part# 1: </font></td>
<td align="left"><input name="partno1" size="25" maxlength="50" tabindex="6"></td>
</tr>
<tr>
<td align="right"><%=font4%> Part# 2: </font></td>
<td align="left"><input name="partno2" size="25" maxlength="50" tabindex="7"></td>
</tr>
<tr>
<td align="right"><%=font4%> Part# 3: </font></td>
<td align="left"><input name="partno3" size="25" maxlength="50" tabindex="8"></td>
</tr>
<tr>
<td align="right"><%=font4%> Part# 4: </font></td>
<td align="left"><input name="partno4" size="25" maxlength="50" tabindex="9"></td>
</tr>
<tr>
<td align="right" valign="top"><%=font4%><font color="#ff0000">* </font>Comments: </td>
<td align="left"><textarea name="message" rows="8" wrap="virtual" cols="20" tabindex="10"></textarea></td>
</tr>
<tr>
<td align="right" valign="top"> </td>
<td align="left">
<%
'Specify your captcha length here
captchaLength = 5
Function captcha(captchaLength)
if captchaLength > 15 then captchaLength = 15
HighestValue = left(100000000000000,captchaLength)
lowestValue = left(999999999999999,captchaLength)
Randomize
intHighestNumber = Int((HighestValue - LowestValue + 1) * Rnd) + LowestValue
session("captcha") = Int(intHighestNumber)
x = 1
response.write vbcrlf & "<table width = ''>" & vbcrlf & vbtab & "<tr>" & vbcrlf
while x <= captchaLength
response.write vbtab & vbtab & "<td align = 'center'><img src = 'captcha.asp?captchaID=" & x & "' ></td>" & vbcrlf
x = x + 1
wend
response.write vbtab & "</tr>" & vbcrlf & "</table>" & vbcrlf
End Function
%>
<%
if request("action") = "captcha" then
if cstr(request("captcha")) = cstr(session("captcha")) then
response.write "Correct!"
else
response.write "Sorry, no match."
end if
end if
%>
Enter Code: <input name="captcha"> <BR />
<input type="submit" name="submit" src="images/b_submit.gif" border="0" tabindex="13" id="image1" value="Submit"></td>
</tr>
</table>
</form>