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HTML Form.

by: Anthony O'Connor
|
April 26, 2001

Version: 1.0

Type: Full Script

Category: HTML

License: GNU General Public License

Description: A simple script allowing a form to be filled and emailed to the corresponding e-mail. It has only a very simple check for certain feilds to be entered but it quite useful.



<HTML>
<HEAD>
<TITLE>html-form</TITLE>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</HEAD>
<?
  /*
   *************
   This very simple enquiry form was written by Sean Gibson
   And is not guaranteed in any way or form.
   This program is free software; you can redistribute it
   and/or modify it under the terms of the GNU GPL.

   This program is distributed in the hope that it will be
   useful, but without any warranty; without even the implied
   warranty of merchantability or fitness for a particular
   purpose. See the GNU General Public License for more
   details. 

   You should not have received a copy of the license referred
   to here as you probably already have one. 
----------------Cut and paste the html code and save as form.html--------------- 
<html>

<head>

<title>Enquiry form</title>

<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">


</head>



<body bgcolor="#FFFFFF">

<form action="/confirm.php" method="POST" >

  <div align="center"> 

    <table width="100%" border="0" cellspacing="0" cellpadding="0">

      <tr> 

        <td height="71"> 

          <div align="center"><font size="6" color="#EABB00"><b><font color="#333399"> 
            <font color="#EABB00">Customer Enquiry Form:</font></font></b></font> 
          </div>

        </td>

      </tr>

    </table>

    <hr width="95%" size="3">

    <div align="center">

      <input type="hidden" name="recipient">

      <input type="hidden"

      name="subject" value="Web Enquiry">

      <input type="hidden" name="redirect"

      value="a web address of your choice">

    </div>

  </div>

  <div align="center"> 

    <table width="51%" border="0" cellspacing="5" cellpadding="5" class="FormCSS" align="center" height="608">
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00"><b><font size="3" face="Times New Roman, Times, serif">Name:</font></b></font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="50"

maxlength="50" name="realname">
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00"><b><font size="3" face="Times New Roman, Times, serif">Organization:</font></b></font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="50" maxlength="50"

name="organisation">
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00" size="3" face="Times New Roman, Times, serif"><b>Address:</b></font> 
          </div>
        </td>
        <td width="67%"> 
          <textarea cols="50" name="address_line_1" rows="5"></textarea>
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00">PostCode:</font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="10" maxlength="15" name="postcode">
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00">Telephone: (incl std:)</font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="50"

maxlength="50" name="telephone">
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00">Fax:</font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="50" maxlength="50"

name="fax">
        </td>
      </tr>
      <tr> 
        <td width="33%"> 
          <div align="left"><font color="#EABB00">Email:</font></div>
        </td>
        <td width="67%"> 
          <input type="text" size="50" maxlength="50" name="email">
        </td>
      </tr>
      <tr> 
        <td width="33%"><font color="#EABB00">Type of enquiry:<br>
          (e.g. repairs, faultfinding etc.)</font></td>
        <td width="67%"> 
          <textarea

name="text" rows="5" cols="50"></textarea>
        </td>
      </tr>
      <tr> 
        <td colspan="2" height="2"> 
          <div align="center"> <font color="#EABB00"> 
            <input type="submit" name="send form" value="Submit Enquiry">
            <input

type="reset" name="clear form" value="Reset Form">
            </font></div>
        </td>
      </tr>
    </table>

  </div>

  <div align="center">
    <div align="right">
      <div align="left">
        <pre class="FormCSS">&nbsp; </pre>
        <c></c></div>
    </div>
  </div>
</form>
<div align="center"><c><a href="index.html"><font face="Times New Roman, Times, serif" size="3" color="#333399"><b><font color="#EABB00">If 
  you do not wish to complete the form Click here to return to the Index Page</font></b></font></a></c> 
</div>
</body>

</html>
----------------------------to here------------------------------------
save the php as confirm.php in your web site
 */

<BODY BGCOLOR="#FFFFFF">
<%
if ((!$realname ) or (!$telephone) && (!$email))  {
	
	echo "Please Enter a Contact Name and either a Telephone Number or an 
		  Email address for Contact purpose's.
		  Thank You";
	echo "<p>";
	echo "Please use the 'Back' button to continue.";
	echo "</p>";
	echo "<a href='/form.html' onclick='self.history.back();'>Back</a>";
	exit;
} 

$message="Name: $realname\n\n"."Organisation: $organisation\n\n"."Address:\n$address_line_1\n\n"."Post Code: $postcode\n\n"."Telephone: $telephone\n\n"."Fax: $fax\n\n"."Email: $email\n\n".
"Message: \n".$text;


mail("your e-mail address","$subject","$message","From:Form.$email\r\nReply-to:$email");
echo "<p>Thank you for completing our contact form. Your details have been forwarded and we will be in contact within 2 working days.</p>";
echo "<p>From: $email</P>";
echo "<p>Subject: $subject</p>";
echo "<p>Message: </p>";
echo "<p>";
echo $text;
echo "</p><a href='/index.html'><b>Return to the Index Page</b></a>";
%>
</BODY>
</HTML>

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