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Please note: All information entered will be considered confidential. Please read our privacy policy.

*First Name :**
*Address :**
City :
State :	Zip:

Telephone :
*Email Address :**

Questions or Comments:

<% strTo = "info@npminc.com" strSub = "REQUEST FOR QUOTE" strHost = "mail.paragon-ins.com" strUser = "mail" strPass = "send2mail" strBody = "

" strBody = strbody & "" strBody = strbody & "" strBody = strbody & "" strBody = strbody & "" strBody = strbody & "

*First Name :**	" & request.form("Firstname") & "
*Last Name :**	" & request.form("LastName") & "
City :	" & request.form("address") & "
City :	" & request.form("city") & "
State :	" & request.form("zip") & " Zip:" & request.form("state") & "

Telephone :	" & request.form("Telephone") & "
*Email Address :**	" & request.form("emailaddress") & "

Your relationship with NPM	" & request.form("Agent") & "Agent " & request.form("Customer") & "Customer " & request.form("News") & "News-Media " & request.form("Visitor") & "Visitor

Questions or Comments:	" & request.form("Comments") & "

" If Request.form("Send") <> "" Then Set Mail = Server.CreateObject("Persits.MailSender") Mail.Host = strHost Mail.Username = strUser Mail.Password = strPass Mail.From = Request.form("var.FromEmail") Mail.FromName = Request.form("var.FromName") Mail.AddAddress strTo Mail.Subject = strSub Mail.IsHTML = True Mail.Body = "" & strBody & "" strErr = "" bSuccess = False On Error Resume Next Mail.Send If Err <> "0" Then strErr = Err.Description else bSuccess = True End If End If %> <% If strErr <> "" Then response.redirect "sent.htm" End If%> <% If bSuccess Then response.redirect "sent.htm" End If %>