CODE FOR SUBMIT MAIL FORM:
<?
if($GET[act]=="a"){ $msg="Details Submitted Successfully!!";}
if($POST[btnSubmit]=="Send")
{
//echo $POST[reason]."hai";exit;
$c=0;
if($POST[reason]==""){ $err=1;$c++;}
if($POST[email]==""){ $err=1;$c++;}
if($POST[Comments]==""){ $err=1;$c++;}
if($c==0)
{
echo "hai";exit;
// here type your email id
$headers = "MIME-Version: 1.0\r\n";
$headers .= "Content-type: text/html; charset=iso-8859-1\r\n";
$headers .= "From: <".$_POST[email].">\r\n";
$mailto = $_POST[reason];
$subject= "Request From ".ucfirst($_POST[firstname])."";
$message="<table width='100%' border='0'>
<tr>
<td height='30' width='28%' >Contact Us Form From $_POST[firstname] </td>
<td height='30' width='72%'> </td>
</tr>
<tr>
<td width='21%' height='30' align='right'><span class='style11 style2'> First Name: </span></td>
<td width='79%' height='30'><span class='style2'>$POST[firstname]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Last Name: </span></td>
<td height='30'><span class='style2'>$POST[lastname]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Address:</span></td>
<td height='30'><span class='style2'>$POST[address]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>City:</span></td>
<td height='30'><span class='style2'>$POST[city]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>State:</span></td>
<td height='30'><span class='style2'>$POST[state]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Zip:</span></td>
<td height='30'><span class='style2'>$POST[zip]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Country:</span></td>
<td height='30'><span class='style2'>$POST[country]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style11 style2'> Email : </span></td>
<td height='30'><span class='style2'>$POST[email]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style11 style2'>Phone Number : </span></td>
<td height='30'><span class='style2'>$POST[phone]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Order Number:</span></td>
<td height='30'><span class='style2'>$POST[ordernumber]</span></td>
</tr>
<tr>
<td height='30' align='right'><span class='style2'>Comments/Inquiry:</span></td>
<td height='30'><span class='style2'>$_POST[comments]</span></td>
</tr>
</table>";
mail($mailto,$subject,$message,$headers);
echo "<script>window.location.href='Contact_us.php?act=a'</script>";
}
}
if($_POST[btnSubmit]=="Cancel")
{
echo "<script>window.location.href='http://www.silicagelpackets.com'</script>";
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Contact Us Form Document</title>
<style type="text/css">
<!--
.style1 {font-family: Verdana, Arial, Helvetica, sans-serif}
.style11 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px; }
.style12 {
color: #FF0000;
font-weight: bold;
}
.style2 {font-size: 12px}
</style>
</style>
<script type="text/javascript">
<!--
function validate_form ( )
{
valid = true;
if ( document.form1.email.value == "" )
{
alert ( "Please fill in the 'Email' box." );
valid = false;
}
if ( document.form1.comments.value == "" )
{
alert ( "Please fill in the 'Comments' box." );
valid = false;
}
return valid;
}
//-->
</script>
</head>
<body><form id="form1" name="form1" method="post" action="" onsubmit="return validate_form ( );">
<table width="100%" border="0">
<tr>
<td align="center"><table width="46%" border="0">
<tr>
<td colspan="2"><h3 class="style1">Contact Form : <span class="style12"><? if($err==1){ "Required fields must be field out!";}?><?=$msg?> </span></h3> </td>
</tr>
<tr>
<td align="right">Reason For Inquiry:</td>
<td>
<select name="reason">
<option selected="selected">Select</option>
<option value="sales@silicagelpackets.com"<? if($POST[reason]=="nandhamkm@gmail.com") echo "selected";?>>Sales Quote</option>
<option value="customerservice@silicagelpackets.com"<? if($POST[reason]=="customerservice@silicagelpackets.com") echo "selected";?>>Order Inquiry</option>
<option value="customerservice@silicagelpackets.com"<? if($POST[reason]=="customerservice@silicagelpackets.com") echo "selected";?>>Order Inquiry</option>
<option value="customerservice@silicagelpackets.com"<? if($POST[reason]=="customerservice@silicagelpackets.com") echo "selected";?>>Order Inquiry</option>
<option value="eric@silicagelpackets.com"<? if($POST[reason]=="eric@silicagelpackets.com") echo "selected";?>>Feedback </option>
<option value="webmaster@silicagelpackets.com"<? if($POST[reason]=="webmaster@silicagelpackets.com") echo "selected";?>>Bug Report</option>
<option value="customerservice@silicagelpackets.com"<? if($POST[reason]=="customerservice@silicagelpackets.com") echo "selected";?>>Help</option>
</select>
</td>
</tr>
<tr>
<td width="50%" align="right"><span class="style11"> First Name: </span></td>
<td width="50%">
<input name="firstname" type="text" value="<?=$POST[firstname]?>" /> </td>
</tr>
<tr>
<td align="right">Last Name: </td>
<td><input name="lastname" type="text" value="<?=$POST[lastname]?>" /></td>
</tr>
<tr>
<td align="right">Address:</td>
<td><input name="address" type="text" value="<?=$POST[address]?>" /></td>
</tr>
<tr>
<td align="right">City:</td>
<td><input name="city" type="text" value="<?=$POST[city]?>" /></td>
</tr>
<tr>
<td align="right">State:</td>
<td><input name="state" type="text" value="<?=$POST[state]?>" /></td>
</tr>
<tr>
<td align="right">Zip:</td>
<td><input name="zip" type="text" value="<?=$POST[zip]?>" /></td>
</tr>
<tr>
<td align="right">Country:</td>
<td><input name="country" type="text" value="<?=$POST[country]?>" /></td>
</tr>
<tr>
<td align="right"><span class="style11"> Email : </span></td>
<td><input name="email" type="text" value="<?=$POST[email]?>" /></td>
</tr>
<tr>
<td align="right"><span class="style11">Phone Number : </span></td>
<td><input name="phone" type="text" value="<?=$POST[phone]?>" /></td>
</tr>
<tr>
<td align="right">Order Number (if applicable):</td>
<td><input name="ordernumber" type="text" value="<?=$POST[ordernumber]?>" /></td>
</tr>
<tr>
<td align="right">Comments/Inquiry*:</td>
<td><textarea name="comments"><?=$POST[comments]?></textarea></td>
</tr>
<tr>
<td align="right"><input type="submit" name="btnSubmit" value="Send" /></td>
<td align="left"><input type="submit" name="btnSubmit" value="Cancel" /></td>
</tr>
</table></td>
</tr>
</table></form>
</body>
</html>