<%@LANGUAGE="VBSCRIPT"%> <% ' *** Edit Operations: declare variables Dim MM_editAction Dim MM_abortEdit Dim MM_editQuery Dim MM_editCmd Dim MM_editConnection Dim MM_editTable Dim MM_editRedirectUrl Dim MM_editColumn Dim MM_recordId Dim MM_fieldsStr Dim MM_columnsStr Dim MM_fields Dim MM_columns Dim MM_typeArray Dim MM_formVal Dim MM_delim Dim MM_altVal Dim MM_emptyVal Dim MM_i MM_editAction = CStr(Request.ServerVariables("SCRIPT_NAME")) If (Request.QueryString <> "") Then MM_editAction = MM_editAction & "?" & Request.QueryString End If ' boolean to abort record edit MM_abortEdit = false ' query string to execute MM_editQuery = "" %> <% ' *** Mail form as Text format *** If (CStr(Request("FX_sendForm")) = "claim") Then names = "" top = "\n" body = "\n" exclude = "Submit,Submit_x,Submit_y,null,FX_sendForm,MM_insert,MM_update" reqArray = split(CStr(Request.Form),"&") For i=0 To UBound(reqArray) name = Left(reqArray(i),InStr(reqArray(i),"=")-1) if (InStr(exclude,name) = 0) Then if (InStr(names,name & ",") = 0) Then body = body & UCase(name) & ": " & CStr(Request.Form(name)) & "\n" names = names & name & "," End If End If Next bottom = "\n" message = Replace(top & body & bottom, "\n", vbCrLf) ' send all set objCDO = Server.CreateObject("CDONTS.NewMail") objCDO.From = CStr(Request.Form("emailaddress")) objCDO.To = "robin@warrenreed.com" objCDO.Cc = "" objCDO.Bcc = "" objCDO.Subject = "Claim submission from the web..." objCDO.Body = message objCDO.Send set objCDO = Nothing ' redirecting body = Server.URLEncode(Replace(body, "\n", "
")) redirect = "thanks.html" If (redirect <> "") Then Response.Redirect(redirect) End If End If %> :: Warren Reed Insurance ::

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Warren Reed Insurance

Submit a Claim ::

At Warren Reed Insurance we know that the coverage you purchase is only as good as the claim service you receive after a loss.  That's why we have a dedicated claims person to help you through the process of filing a claim as well as keep you updated on the progress of your claim. Simply fill out the information below and we will contact you no later than the next business day.

Any claims submitted after 2:00pm will not be received in our office until the next business day.