*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State: <% Set rs2 = Server.CreateObject("ADODB.Recordset") strSQL = "SELECT * FROM lu_state" rs2.Open strSQL, objConn, 3, 2 Do While Not rs2.EOF %> "><%= rs2("StateFull") %> <% rs2.MoveNext Loop rs2.close set rs2 = Nothing %>
*Zip:
*Phone: xxx-xxx-xxxx
*Email:
*Model: SELECT YOUR MODEL UM6096 UM4884 UM4872 UM4872SE UM6096EZ UM4884EZ UM4872EZ UM5806 UM5288 UM581 UM583
*Purchase Date: <% Dim m m = 0 for m = 1 to 12 %> <%= MonthName(m) %> <% next %> <% Dim d d = 0 for d = 1 to 31 %> <%= d %> <% next %> <% Dim y y = 0 for y = (FormatNumber(Year(date)) - 1) to Year(date) %> <%= y %> <% next %>
*Age: 18-24 25-34 35-49 50-64 65+
*Gender: Male Female
*Vin #:
*Retype Vin #:
*Dealer Name:
