<%@language="javascript" %> <% // checking if form was posted if(Request.Form("isPost")=="yes"){ var strLeadSite="creditcarddebtmanagement.org.uk"; var strData=Request.Form()+""; strData+="&leadsite="+strLeadSite; main(); }else{ var strFirstName = Session("firstname"); var strLastName = Session("lastname"); var strPostcode = Session("postcode"); var strTelephone = Session("telephone"); var strMobile = Session("mobile"); } // creating functions function echo(str){ Response.Write(str); } function main(){ postResultToOurService(strData); Response.Redirect("thankyou.html"); } function postResultToOurService(strLead){ try{ var objXMLHTTP_Log = Server.CreateObject("Msxml2.XMLHTTP"); var strServiceURL_Log = "http://94.136.39.80/loanhub/dm/main.php"; objXMLHTTP_Log.open("POST",strServiceURL_Log,false); objXMLHTTP_Log.setRequestHeader("Content-Type", "application/x-www-form-urlencoded"); var strData=strLead+""; objXMLHTTP_Log.send(strData); //echo(objXMLHTTP_Log.responseText); }catch(ex){ var strError = "/////// ERROR IN POSTING RESULT TO SERVICE /////\r\n"; strError += ex.description + "\r\n"; strError += "for " + Request.Form+""; logError(strError); } } %> Loan Application Form

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Salutation
First Name
LastName
Annual Income
Telephone(Home)
Telephone(Office)
Mobile
House name/Number
Postcode
Amount of Unsecured Debt
How many creditors
Are you struggling with your debts? Yes No
 
THINK CAREFULLY BEFORE SECURING OTHER DEBTS AGAINST YOUR HOME. YOUR HOME MAY BE REPOSSESSED IF YOU DO NOT KEEP UP REPAYMENTS ON A MORTGAGE OR ANY OTHER DEBT SECURED ON IT.
Valid CSS! Valid CSS!