Here is the link to the page I am trying to make work. http://www.andyrichin.com/DEV/htmlform.htm
This is my HTML code:
- Code: Select all
<form name="htmlform" method="post" action="html_form_send.php">
<table width="550px">
</tr>
<tr>
<td valign="top">
<label for="first_name" style="font-family:Century Gothic; font-size:12px;">First Name *</label>
</td>
<td valign="top">
<input type="text" name="first_name" maxlength="50" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="last_name" style="font-family:Century Gothic; font-size:12px;">Last Name *</label>
</td>
<td valign="top">
<input type="text" name="last_name" maxlength="50" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="email" style="font-family:Century Gothic; font-size:12px;">Email Address *</label>
</td>
<td valign="top">
<input type="text" name="email" maxlength="80" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="telephone" style="font-family:Century Gothic; font-size:12px;">Cell Phone Number *</label>
</td>
<td valign="top">
<input type="text" name="telephone" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="age" style="font-family:Century Gothic; font-size:12px;">Age *</label>
</td>
<td valign="top">
<input type="text" name="age" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="occupation" style="font-family:Century Gothic; font-size:12px;">Occupation *</label>
</td>
<td valign="top">
<input type="text" name="occupation" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="location" style="font-family:Century Gothic; font-size:12px;">Requested Location *</label>
</td>
<td valign="top">
<input type="text" name="location" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="city" style="font-family:Century Gothic; font-size:12px;">City Where You Live *</label>
</td>
<td valign="top">
<input type="text" name="city" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="state" style="font-family:Century Gothic; font-size:12px;">State Where You Live *</label>
</td>
<td valign="top">
<input type="text" name="state" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="preferred_date" style="font-family:Century Gothic; font-size:12px;">Preferred Date *</label>
</td>
<td valign="top">
<select name="preferred_date">
<option>01</option>
<option>02</option>
<option>03</option>
<option>04</option>
<option>05</option>
<option>06</option>
<option>07</option>
<option>08</option>
<option>09</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
</select>
<select name="preferred_date">
<option>January</option>
<option>February</option>
<option>March</option>
<option>April</option>
<option>May</option>
<option>June</option>
<option>July</option>
<option>August</option>
<option>September</option>
<option>October</option>
<option>November</option>
<option>December</option>
</select>
<select name="preferred_date">
<option>2011</option>
<option>2012</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label for="preferred_time" style="font-family:Century Gothic; font-size:12px;">Preferred Time *</label>
</td>
<td valign="top">
<select name="preferred_time">
<option>10am</option>
<option>11am</option>
<option>12pm</option>
<option>1pm</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label for="meeting_type" style="font-family:Century Gothic; font-size:12px;">Length Of Meeting *</label>
</td>
<td valign="top">
<select name="meeting_type">
<option>One Hour Date (incall only) $300.00</option>
<option>Two Hour Date (incall only) $500.00</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label for="reference_1" style="font-family:Century Gothic; font-size:12px;">Reference #1 *</label>
</td>
<td valign="top">
<input type="text" name="reference_1" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="reference_1number" style="font-family:Century Gothic; font-size:12px;">Reference #1 Phone Number *</label>
</td>
<td valign="top">
<input type="text" name="reference_1number" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="reference_2" style="font-family:Century Gothic; font-size:12px;">Reference #2 *</label>
</td>
<td valign="top">
<input type="text" name="reference_2" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="reference_2number" style="font-family:Century Gothic; font-size:12px;">Reference #2 Phone Number *</label>
</td>
<td valign="top">
<input type="text" name="reference_2number" maxlength="30" size="30">
</td>
</tr>
<tr>
<td valign="top">
<label for="comments" style="font-family:Century Gothic; font-size:12px;">Comments or Requests *</label>
</td>
<td valign="top">
<textarea name="comments" maxlength="1000" cols="25" rows="6"></textarea>
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center">
<!-- We are grateful to you for keeping this link in place. thank you. -->
<input type="submit" value="Submit"> <!--( <a href="http://www.freecontactform.com/html_form.php">HTML Form</a> )-->
</td>
</tr>
</table>
</form>
And this is my PHP code:
- Code: Select all
<?php
if(isset($_POST['email'])) {
// CHANGE THE TWO LINES BELOW
$email_to = "andy.richin@gmail.com";
$email_subject = "website html form submissions";
function died($error) {
// your error code can go here
echo "We're sorry, but there's errors found with the form you submitted.<br /><br />";
echo $error."<br /><br />";
echo "Please go back and fix these errors.<br /><br />";
die();
}
// validation expected data exists
if(!isset($_POST['first_name']) ||
!isset($_POST['last_name']) ||
!isset($_POST['email']) ||
!isset($_POST['telephone']) ||
!isset($_POST['age']) ||
!isset($_POST['occupation']) ||
!isset($_POST['location']) ||
!isset($_POST['city']) ||
!isset($_POST['state']) ||
!isset($_POST['preferred_date']) ||
!isset($_POST['preferred_time']) ||
!isset($_POST['meeting_type']) ||
!isset($_POST['reference_1']) ||
!isset($_POST['reference_1number']) ||
!isset($_POST['reference_2']) ||
!isset($_POST['reference_2number']) ||
!isset($_POST['comments'])) {
died('We are sorry, but there appears to be a problem with the form you submitted.');
}
$first_name = $_POST['first_name']; // required
$last_name = $_POST['last_name']; // required
$email_from = $_POST['email']; // required
$telephone = $_POST['telephone']; // required
$age = $_POST['age']; // required
$occupation = $_POST['occupation']; // required
$location = $_POST['location']; // required
$city = $_POST['city']; // required
$state = $_POST['state']; // required
$preferred_date = $_POST['preferred_date']; // required
$preferred_time = $_POST['preferred_time']; // required
$meeting_type = $_POST['meeting_type']; // required
$reference_1 = $_POST['reference_1']; // required
$reference_1number = $_POST['reference_1number']; // required
$reference_2 = $_POST['reference_2']; // required
$reference_2number = $_POST['reference_2number']; // required
$comments = $_POST['comments']; // required
$error_message = "";
$email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}$/';
if(!preg_match($email_exp,$email_from)) {
$error_message .= 'The Email Address you entered does not appear to be valid.<br />';
}
$string_exp = "/^[A-Za-z .'-]+$/";
if(!preg_match($string_exp,$first_name)) {
$error_message .= 'The First Name you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$last_name)) {
$error_message .= 'The Last Name you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$telephone)) {
$error_message .= 'The Telephone Number you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$age)) {
$error_message .= 'The Age you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$occupation)) {
$error_message .= 'The Occupation you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$location)) {
$error_message .= 'The Requested Location you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$city)) {
$error_message .= 'The City you entered does not appear to be valid.<br />';
}
if(!preg_match($string_exp,$state)) {
$error_message .= 'The State you entered does not appear to be valid.<br />';
}
if(strlen($preferred_date) < 2) {
$error_message .= 'The Preferred Date you entered does not appear to be valid.<br />';
}
if(strlen($preferred_time) < 2) {
$error_message .= 'The Preferred Time you entered do not appear to be valid.<br />';
}
if(strlen($meeting_type) < 2) {
$error_message .= 'The Meeting type you entered do not appear to be valid.<br />';
}
if(!preg_match($string_exp,$reference_1)) {
$error_message .= 'The First Reference you entered do not appear to be valid.<br />';
}
if(!preg_match($string_exp,$reference_1number)) {
$error_message .= 'The First Reference number you entered do not appear to be valid.<br />';
}
if(!preg_match($string_exp,$reference_2)) {
$error_message .= 'The Second Reference you entered do not appear to be valid.<br />';
}
if(!preg_match($string_exp,$reference_2number)) {
$error_message .= 'The Second Reference number you entered do not appear to be valid.<br />';
}
if(strlen($comments) < 2) {
$error_message .= 'The Comments you entered do not appear to be valid.<br />';
}
if(strlen($error_message) > 0) {
died($error_message);
}
$email_message = "Form details below.\n\n";
function clean_string($string) {
$bad = array("content-type","bcc:","to:","cc:","href");
return str_replace($bad,"",$string);
}
$email_message .= "First Name: ".clean_string($first_name)."\n";
$email_message .= "Last Name: ".clean_string($last_name)."\n";
$email_message .= "Email: ".clean_string($email_from)."\n";
$email_message .= "Telephone: ".clean_string($telephone)."\n";
$email_message .= "Age: ".clean_string($age)."\n";
$email_message .= "Occupation: ".clean_string($occupation)."\n";
$email_message .= "Requested Location: ".clean_string($location)."\n";
$email_message .= "City You Live In: ".clean_string($city)."\n";
$email_message .= "State You Live In: ".clean_string($state)."\n";
$email_message .= "Preferred Date: ".clean_string($preferred_date)."\n";
$email_message .= "Preferred Time: ".clean_string($preferred_time)."\n";
$email_message .= "Meeting Type: ".clean_string($meeting_type)."\n";
$email_message .= "Reference 1: ".clean_string($reference_1)."\n";
$email_message .= "Reference 1 Phone Number: ".clean_string($reference_1number)."\n";
$email_message .= "Reference 2: ".clean_string($reference_2)."\n";
$email_message .= "Reference 2 Phone Number: ".clean_string($reference_2number)."\n";
$email_message .= "Comments: ".clean_string($comments)."\n";
// create email headers
$headers = 'From: '.$email_from."\r\n".
'Reply-To: '.$email_from."\r\n" .
'X-Mailer: PHP/' . phpversion();
@mail($email_to, $email_subject, $email_message, $headers);
?>
<!-- place your own success html below -->
Thank you for contacting us. We will be in touch with you very soon.
<?php
}
die();
?>
