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dannymichel/contact.php

Created May 23, 2016 14:36
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Raw
contact.php
<form action="contactengine.php" class="appnitro" enctype="text/plain" id=
"form_1133213" method="post" name="form_1133213">
<div class="form_description"></div>
<ul>
<li id="Name">
<label class="description" for="Name">Name</label>
<div>
<input class="element text medium" id="Name" maxlength="255" name="Name"
type="text" value="">
</div>
</li>
<li id="Company">
<label class="description" for="Company">Company</label>
<div>
<input class="element text medium" id="Company" maxlength="255" name=
"Company" type="text" value="">
</div>
</li>
<li id="Email">
<label class="description" for="Email">Email</label>
<div>
<input class="element text medium" id="Email" maxlength="255" name="Email"
type="text" value="">
</div>
</li>
<li id="Phone">
<label class="description" for="Phone">Phone</label>
<div>
<input class="element text medium" id="Phone" maxlength="255" name="Phone"
type="text" value="">
</div>
</li>
<li id="City">
<label class="description" for="City">City</label>
<div>
<input class="element text medium" id="City" maxlength="255" name="City"
type="text" value="">
</div>
</li>
<li id="State">
<label class="description" for="State">State</label>
<div>
<select class="element select medium" id="State" name="State">
<option selected="selected" value="">
</option>
<option value="1">
Alabama
</option>
<option value="2">
Alaska
</option>
<option value="3">
Arizona
</option>
<option value="4">
Arkansas
</option>
<option value="5">
California
</option>
<option value="6">
Colorado
</option>
<option value="7">
Connecticut
</option>
<option value="8">
Delaware
</option>
<option value="9">
Florida
</option>
<option value="10">
Georgia
</option>
<option value="11">
Hawaii
</option>
<option value="12">
Idaho
</option>
<option value="13">
Illinois
</option>
<option value="14">
Indiana
</option>
<option value="15">
Iowa
</option>
<option value="16">
Kansas
</option>
<option value="17">
Kentucky
</option>
<option value="18">
Louisiana
</option>
<option value="19">
Maine
</option>
<option value="20">
Maryland
</option>
<option value="21">
Massachusetts
</option>
<option value="22">
Michigan
</option>
<option value="23">
Minnesota
</option>
<option value="24">
Mississippi
</option>
<option value="25">
Missouri
</option>
<option value="26">
Montana
</option>
<option value="27">
Nebraska
</option>
<option value="28">
Nevada
</option>
<option value="29">
New Hampshire
</option>
<option value="30">
New Jersey
</option>
<option value="31">
New Mexico
</option>
<option value="32">
New York
</option>
<option value="33">
North Carolina
</option>
<option value="34">
North Dakota
</option>
<option value="35">
Ohio
</option>
<option value="36">
Oklahoma
</option>
<option value="37">
Oregon
</option>
<option value="38">
Pennsylvania
</option>
<option value="39">
Rhode Island
</option>
<option value="40">
South Carolina
</option>
<option value="41">
South Dakota
</option>
<option value="42">
Tennessee
</option>
<option value="43">
Texas
</option>
<option value="44">
Utah
</option>
<option value="45">
Vermont
</option>
<option value="46">
Virginia
</option>
<option value="47">
Washington
</option>
<option value="48">
West Virginia
</option>
<option value="49">
Wisconsin
</option>
<option value="50">
Wyoming
</option>
</select>
</div>
</li>
<li id="Zip">
<label class="description" for="Zip">Zip code</label>
<div>
<input class="element text medium" id="Zip" maxlength="255" name="Zip"
type="text" value="">
</div>
</li>
<li id="How">
<label class="description" for="How">How did you hear about us?</label>
<div>
<select class="element select medium" id="How" name="How">
<option selected="selected" value="">
</option>
<option value="1">
Martindale.com
</option>
<option value="2">
Lawyers.com
</option>
<option value="3">
Press release
</option>
<option value="4">
Video
</option>
<option value="5">
Yahoo
</option>
<option value="6">
MSN
</option>
<option value="7">
Internet search
</option>
<option value="8">
Publication
</option>
<option value="9">
Recent case
</option>
<option value="10">
Referral
</option>
</select>
</div>
</li>
<li id="contacted">
<label class="description" for="contacted">How would you like to be
contacted?</label>
<div>
<select class="element select medium" id="contacted" name="contacted">
<option selected="selected" value="">
</option>
<option value="1">
Phone
</option>
<option value="2">
Email
</option>
</select>
</div>
</li>
<li id="Reason">
<label class="description" for="Reason">Reason you would like to be
contacted</label>
<div>
<textarea class="element textarea medium" id="Reason" name=
"Reason"></textarea>
</div>
</li>
<li id="agree"><label class="description" for="agree">I agree to the terms in
the disclaimer</label> <span><input class="element checkbox" id="agree" name=
"agree" type="checkbox" value="1"></span></li>
<li class="buttons">
<input name="form_id" type="hidden" value="1133213">
<div class="g-recaptcha" data-sitekey=
"6LfwgSATAAAAANB824fo1raRkY47Sh8pX-GWlNK9"></div><input class="button_text"
id="saveForm" name="submit" type="submit" value="Submit">
</li>
</ul>
</form><?php } ?><!-- /Contact -->
Raw
contactengine.php
<?php
$EmailFrom = "danieldimichel@gmail.com";
$EmailTo = "danieldimichel@gmail.com";
$Subject = "Contact form";
$Name = Trim(stripslashes($_POST['Name']));
$Company = Trim(stripslashes($_POST['Company']));
$Email = Trim(stripslashes($_POST['Email']));
$Phone = Trim(stripslashes($_POST['Phone']));
$City = Trim(stripslashes($_POST['City']));
$State = Trim(stripslashes($_POST['State']));
$Zip = Trim(stripslashes($_POST['Zip']));
$How = Trim(stripslashes($_POST['How']));
$contacted = Trim(stripslashes($_POST['contacted']));
$Reason = Trim(stripslashes($_POST['Reason']));
$agree = Trim(stripslashes($_POST['agree']));
// validation
$validationOK=true;
if (!$validationOK) {
print "<meta http-equiv=\"refresh\" content=\"0;URL=error.htm\">";
exit;
}
// prepare email body text
$Body = "";
$Body .= "Name: ";
$Body .= $Name;
$Body .= "\n";
$Body .= "Company: ";
$Body .= $Company;
$Body .= "\n";
$Body .= "Email: ";
$Body .= $Email;
$Body .= "\n";
$Body .= "Phone: ";
$Body .= $Phone;
$Body .= "\n";
$Body .= "City: ";
$Body .= $City;
$Body .= "\n";
$Body .= "Zip: ";
$Body .= $Zip;
$Body .= "\n";
$Body .= "How: ";
$Body .= $How;
$Body .= "\n";
$Body .= "contacted: ";
$Body .= $contacted;
$Body .= "\n";
$Body .= "Reason: ";
$Body .= $Reason;
$Body .= "\n";
$Body .= "agree: ";
$Body .= $agree;
$Body .= "\n";
// send email
$success = mail($EmailTo, $Subject, $Body, "From: <$EmailFrom>");
// redirect to success page
if ($success){
print "<meta http-equiv=\"refresh\" content=\"0;URL=contactthanks.php\">";
}
else{
print "<meta http-equiv=\"refresh\" content=\"0;URL=error.htm\">";
}
?>
Raw
contactthanks.php
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Strict//EN">
<head>
<title>Thank you</title>
<link rel="stylesheet" type="text/css" href="style.css" />
</head>
<body>
<div id="page-wrap">
<h1>Your message has been sent!</h1><br />
<p><a href="index.php">Back to Contact Form</a></p>
</div>
</body>
</html>
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