<form name="form1" method="post" action="survey-code.asp">
  <p>
    <input name="email" type="text" id="email">
  </p>
  <p>
    <select name="list1" id="list1">
      <option>a</option>
      <option>b</option>
      <option>c</option>
    </select>
  </p>
  <p> 
    <select name="list2" id="list2">
      <option>a</option>
      <option>b</option>
      <option>c</option>
    </select>
  </p>
  <p> 
    <select name="list3" id="list3">
      <option>a</option>
      <option>b</option>
      <option>c</option>
    </select>
  </p>
  <p>
    <input type="submit" name="Submit" value="Submit">
  </p>
</form>

<%
Response.Buffer = True
Dim strBody    'Holds the body of the e-mail
Dim objJMail    'Holds the mail server object
Dim strMyEmailAddress   'Holds your e-mail address
Dim strSMTPServerAddress 'Holds the SMTP Server address
Dim strCCEmailAddress  'Holds any carbon copy e-mail addresses if you want to send carbon copies of the e-mail
Dim strBCCEmailAddress  'Holds any blind copy e-mail addresses if you wish to send blind copies of the e-mail
Dim strReturnEmailAddress 'Holds the return e-mail address of the user
strMyEmailAddress = "info@example.com"
strSMTPServerAddress = "smtp.example.com"
strCCEmailAddress = "infocc@example.com" 'Use this string only if you want to send the carbon copies of the e-mail
strBCCEmailAddress = ""
strReturnEmailAddress = Request.Form("email")
strBody = "<h2>E-mail sent from form on Web Site</h2>"
strBody = strBody & "<br><b>Name: </b>" & Request.Form("Name")
strBody = strBody & "<br><b>E-mail: </b>" & strReturnEmailAddress
strBody = strBody & "<br><b>Question: </b>" & request.form("question")
If Len(strReturnEmailAddress) < 5 OR NOT Instr(1, strReturnEmailAddress, " ") = 0 OR InStr(1, strReturnEmailAddress, "@", 1) < 2 OR InStrRev(strReturnEmailAddress, ".") < InStr(1, strReturnEmailAddress, "@", 1) Then
 strReturnEmailAddress = strMyEmailAddress
End If 

Set objJMail = Server.CreateObject("JMail.SMTPMail")
objJMail.ServerAddress = strSMTPServerAddress
objJMail.Sender = strReturnEmailAddress
objJMail.SenderName = Request.Form("Name")
objJMail.AddRecipient strMyEmailAddress
objJMail.AddRecipientCC strCCEmailAddress
objJMail.AddRecipientBCC strBCCEmailAddress
objJMail.Subject = "Enquiry sent from enquiry form on website"
objJMail.HTMLBody = strBody
'objJMail.Body = strBody
objJMail.Priority = 3 
objJMail.Execute
 
Set objJMail = Nothing
%>