I did make a database with the fields but do not know were to go. Please help thank you
<?php
/ Subject and Email Variables /
$emailSubject = 'rcirone!';
$WebMaster = 'email@mail.com';
/ Gathering Data Variables /
$agent = $_POST['agent'];
$case = $_POST['case'];
$frist = $_POST['frist'];
$callback = $_POST['callback'];
$Problem = $_POST['Problem'];
$iPhone = $_POST['iPhone'];
$Kindle = $_POST['Kindle'];
$Storm = $_POST['Storm'];
$Curve = $_POST['Curve'];
$Bold = $_POST['Bold'];
$OS = $_POST['OS'];
$Notes = $_POST['Notes'];
$Done = $_POST['Done'];
$body = <<<EOD
<br><hr><br>
agent: $agent <br>
case: $case <br>
frist: $frist <br>
callback: $callback <br>
Problem: $Problem <br>
iPhone: $iPhone <br>
Kindle: $Kindle <br>
Storm: $Storm <br>
Curve: $Curve <br>
Bold: $Bold <br>
OS: $OS <br>
Notes: $Notes <br>
Done: $Done <br>
EOD;
$headers = "From: $email\r\n";
$headers = "Content-type: text/html\r\n";
$success = mail($WebMaster, $emailSubject, $body, $headers);
header('Location: confirmation.html');
exit();
/ Results render as HTML /
$theResults = <<<EOD
<html>
<head>
<title>rcirone</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<style type="text/css">
<!--
body {
background-color: #f1f1f1;
font-family: Verdana, Arial, Helvetica, sans-serif;
font-size: 12px;
font-style: normal;
line-height: normal;
font-weight: normal;
color: #666666;
text-decoration: none;
}
#formHolder {
width: 800px;
background-color: e1e1e1;
}
-->
</style>
<script type="text/JavaScript">
<!--
function MM_preloadImages() { //v3.0
var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array();
var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++)
if (a.indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a;}}
}
//-->
</script>
</head>
<body leftmargin="0" topmargin="0" marginwidth="0" marginheight="0">
<div id="formHolder">
<form name="form1" method="post" action="bncaselog.php">
<table width="100%" border="0" cellspacing="0" cellpadding="6">
<tr>
<th> Barnes and Noble</th>
<th>Case Tracker</th>
</tr>
<tr>
<td><label for="email">
<div align="right">Agent:</div>
</label>
</td>
<td><div align="left">
<input name="agent" type="text" id="agent" size="35" maxlength="100">
</div></td>
</tr>
<tr>
<td><label for="name">
<div align="right">Case Number:</div>
</label>
</td>
<td><div align="left">
<input name="case" type="text" id="case" size="35" maxlength="80">
</div></td>
</tr>
<tr>
<td><label for="phone">
<div align="right">Date of frist call:</div>
</label>
</td>
<td><div align="left">
<input name="frist" type="text" id="frist" size="35" maxlength="12">
</div></td>
</tr>
<tr>
<td><label for="name">
<div align="right">Date of call back:</div>
</label>
</td>
<td><div align="left">
<input name="callback" type="text" id="callback" size="35" maxlength="80">
</div></td>
</tr>
<tr>
<td><label for="phone">
<div align="right">Main Problem:</div>
</label>
</td>
<td><div align="left">
<input name="Problem" type="text" id="Problem" size="35" maxlength="12">
</div></td>
</tr>
<tr>
<td><div align="right">Device:</div></td>
<td><p align="left">
<label>
<input type="radio" name="iPhone" value="Yes" id="device_0">
iPhone</label>
<br>
<label>
<input type="radio" name="Kindle" value="Yes" id="device_1">
Kindle</label>
<br>
<label>
<input type="radio" name="Storm" value="Yes" id="device_2">
Black Berry Storm</label>
9500<br>
<label>
<input type="radio" name="Curve" value="Yes" id="device_3">
Black Berry Curve 8330</label>
<br>
<label>
<input type="radio" name="Bold" value="Yes" id="device_4">
Black Berry Bold 9000</label>
<br>
</p></td>
</tr>
<tr>
<td><div align="right">
<label for="OS">OS?</label>
</div></td>
<td><div align="left">
<select name="OS" id="OS">
<option>Choose...</option>
<option value="Windows 2000">Windows 2000</option>
<option value="Windows XP">Windows XP</option>
<option value="Windows Vista">Windows Vista</option>
<option value="N/A">N/A</option>
</select>
</div></td>
</tr>
<tr>
<td><div align="right">
<label for="Notes">Notes:</label>
</div></td>
<td><div align="left">
<textarea name="Notes" id="Notes" cols="26" rows="5"></textarea>
</div></td>
</tr>
<tr>
<td><div align="right"></div></td>
<td><div align="left">
<input name="Done" type="checkbox" id="Done" value="completed">
Done </div></td>
</tr>
<tr>
<td><div align="right">
<label for="clear"></label>
<input type="reset" name="clear" id="clear" value="Reset Form">
</div></td>
<td><div align="right">
<label for="submit"></label>
<div align="left">
<input type="submit" name="submit" id="submit" value="Submit!">
</div>
</div></td>
</tr>
</table>
</form>
<p align="center"> </p>
</div>
</body>
</html>
EOD;
echo "$theResults";
