I am not having any luck with a form I am writing for an insurance quote.
here is the quote.html bowlfreaks.com/gbj/quote.html and here is my php.
When submitted, it breaks to error page.
Any thoughts?
PHP Code:
<?php
$mailto = '***********@gmail.com' ;
$subject = "Insurance Quote" ;
$formurl = "http://bowlfreaks.com/gbj/quote.html" ;
$errorurl = "http://www.yoursite.com/error.html" ;
$thankyouurl = "http://www.yoursite.com/thankyou.html" ;
$uself = 0;
$use_sendmailfrom = 0;
$use_webmaster_email_for_from = 0;
$use_utf8 = 1;
$headersep = (!isset( $uself ) || ($uself == 0)) ? "\r\n" : "\n" ;
$content_type = (!isset( $use_utf8 ) || ($use_utf8 == 0)) ? 'Content-Type: text/plain; charset="iso-8859-1"' : 'Content-Type: text/plain; charset="utf-8"' ;
if (isset( $use_sendmailfrom ) && $use_sendmailfrom) {
ini_set( 'sendmail_from', $mailto );
}
$firstname = addslashes($_POST['firstname']) ;
$lastname = addslashes($_POST['lastname']) ;
$birth = addslashes($_POST['birth']) ;
$Address = addslashes($_POST['Address']) ;
$city = addslashes($_POST['city']) ;
$state = addslashes($_POST['state']) ;
$zip = addslashes($_POST['zip']) ;
$homephone = addslashes($_POST['homephone']) ;
$workphone = addslashes($_POST['workphone']) ;
$email = addslashes($_POST['email']) ;
$head = addslashes($_POST['head']) ;
$Gender = addslashes($_POST['Gender']) ;
$marital = addslashes($_POST['marital']) ;
$social = addslashes($_POST['social']) ;
$licensed = addslashes($_POST['licensed']) ;
$driven = addslashes($_POST['driven']) ;
$tickets = addslashes($_POST['tickets']) ;
$accidents = addslashes($_POST['accidents']) ;
$subject = addslashes($_POST['subject']) ;
$message = addslashes($_POST['message']) ;
$http_referrer = getenv( "HTTP_REFERER" );
if (!isset($_POST['email'])) {
header( "Location: $formurl" );
exit ;
}
$valid_email = (preg_match('/^[A-Z0-9._%-]+@[A-Z0-9.-]+\\.[A-Z]{2,4}$/im', $email)) ? true : false;
$valid_firstname = (!empty($firstname)) ? true : false;
$valid_lastname = (!empty($lastname)) ? true : false;
$valid_birth = (!empty($birth)) ? true : false;
$valid_Address = (!empty($Address)) ? true : false;
$valid_city = (!empty($city)) ? true : false;
$valid_state = (!empty($state)) ? true : false;
$valid_zip = (!empty($zip)) ? true : false;
$valid_homephone = (!empty($homephone)) ? true : false;
$valid_workphone = (!empty($workphone)) ? true : false;
$valid_email = (!empty($email)) ? true : false;
$valid_head = (!empty($head)) ? true : false;
$valid_Gender = (!empty($Gender)) ? true : false;
$valid_marital = (!empty($marital)) ? true : false;
$valid_social = (!empty($social)) ? true : false;
$valid_licensed = (!empty($licensed)) ? true : false;
$valid_driven = (!empty($driven)) ? true : false;
$valid_tickets = (!empty($tickets)) ? true : false;
$valid_accidents = (!empty($accidents)) ? true : false;
$valid_message = (!empty($subject) && !empty($message)) ? true : false;
$fromemail = (!isset( $use_webmaster_email_for_from ) || ($use_webmaster_email_for_from == 0)) ? $email : $mailto ;
if (get_magic_quotes_gpc()) {
$process = array(&$_GET, &$_POST, &$_COOKIE, &$_REQUEST);
while (list($key, $val) = each($process)) {
foreach ($val as $k => $v) {
unset($process[$key][$k]);
if (is_array($v)) {
$process[$key][stripslashes($k)] = $v;
$process[] = &$process[$key][stripslashes($k)];
} else {
$process[$key][stripslashes($k)] = stripslashes($v);
}
}
}
unset($process);
}
$messageproper =
"This message was sent from:\n" .
"$http_referrer\n" .
"------------------------------------------------------------\n" .
"First Name: $firstname\n" .
"Last Name: $lastname\n" .
"City: $city\n" .
"State: $state\n" .
"Phone: $phone\n" .
"Email: $email\n" .
"Website: $website\n" .
"Subject: $subject\n" .
"------------------------- MESSAGE -------------------------\n\n" .
$message .
"\n\n------------------------------------------------------------\n" ;
$headers = "From: \"$firstname\" <$fromemail>" . $headersep . "Reply-To: \"$firstname\" <$email>" . $headersep . "X-Mailer: chfeedback.php 2.15.0" . $headersep . 'MIME-Version: 1.0' . $headersep . $content_type ;
if ($valid_email && $valid_firstname && $valid_lastname && $valid_city && $valid_state && $valid_message) {
mail( $mailto, $subject, $messageproper, $headers );
}
else {
header( "Location: $errorurl" );
exit ;
}
header( "Location: $thankyouurl" );
exit ;
?>
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