The previous administrator of my website had a customer information page on my site and now I am trying to expand it. I know this needs a lot of work and can be condensed but right I just want to get my form to display correctly.
the url is
http://admin.pctoolmanconsulting.com/pctoolman_forms/computer_info2.php
when it loads I get Client Information Sheet only. Can someone help me with this? Thanks.
<html>
<head>
<style type="text/css">
<!--
.edit {color: #990000}
-->
</style>
<title>PC TOOL MAN CONSULTING | Admin Section</title>
</head>
<body>
<div style="text-align: right; margin: 0 auto; width: 530px;">
<h3 align="center">Client Information Sheet</h3><br/>
<p style="text-align: left; font-weight: bold;">
</p>
<div id="addinfo" style="display: none;">
<form method="post" action="" name="add_clients">
<table width="530" cellspacing="10" cellpadding="10">
<tr>
<td>
<label><strong>Client Type:</strong></label>
<input type="radio" name=box[] value="c" /><label>Company</label>
<input type="radio" name=box[] value="i" /><label>Individual</label>
</td>
<td></td>
</tr>
<tr>
<td colspan="2"><br/><h5 align="left">COMPUTER INFORMATION</h5></td>
</tr>
<tr>
<td>
<label>Type:</label>
<input type="checkbox" name=box2[] value="desktop" /><label>Desktop</label>
<input type="checkbox" name=box2[] value="laptop" /><label>Laptop</label>
<input type="checkbox" name=box2[] value="mac" /><label>Mac</label>
</td>
<td> </td>
</tr>
<tr>
<td><label>Brand: </label><input type="text" maxlength="60" value="<?=$_REQUEST['brand']?>" name="brand" /></td>
<td><label>Product Line: </label><input type="text" maxlength="60" value="<?=$_REQUEST['line']?>" name="line" /></td>
</tr>
<tr>
<td><label>Model #: </label><input type="text" maxlength="60" value="<?=$_REQUEST['model']?>" name="model" /></td>
<td><label>OS: </label><input type="text" maxlength="30" value="<?=$_REQUEST['os']?>" name="os" /></td>
</tr>
<tr>
<td><label>HDD1: </label><input type="text" maxlength="10" value="<?=$_REQUEST['hd1']?>" name="hd1" /></td>
<td><label>Ram: </label><input type="text" maxlength="10" value="<?=$_REQUEST['ram']?>" name="ram" /></td>
</tr>
<tr>
<td><label>Computer Condition: </label><input type="text" maxlength="60" value="<?=$_REQUEST['condition']?>" name="condition" /></td>
<td colspan="2"><label>Issue: </label><textarea name="Issue" cols="50" rows="5"><?=$_REQUEST['issue']?></textarea></td>
</tr>
<tr>
<td><label>Passwords </label><input type="text" maxlength="20" value="<?=$_REQUEST['passwords']?>" name="passwords" /></td>
</tr>
<tr>
<td>
<label>Power Supply:</label>
<input type="checkbox" name=box2[] value="yes" /><label>Yes</label>
<input type="checkbox" name=box2[] value="no" /><label>No</label>
</td>
<tr>
<td><label>Software Discs: </label></td>
<input type="checkbox" name=box2[] value="yes" /><label>Yes</label>
<input type="checkbox" name=box2[] value="no" /><label>No</label>
</tr>
<tr>
<td><label>Service Type:</label></td>
<input type="checkbox" name=box2[] value="diagnosis" /><label>Diagnosis Needed</label>
<input type="checkbox" name=box2[] value="opt" /><label>Optimazation</label>
<input type="checkbox" name=box2[] value="virus" /><label>Virus/Trojan Removal</label>
<input type="checkbox" name=box2[] value="hdupgrade" /><label>Hardware Upgrade</label>
<input type="checkbox" name=box2[] value="screen" /><label>Screen Replacement</label>
<input type="checkbox" name=box2[] value="sinstall" /><label>Software Install</label>
<input type="checkbox" name=box2[] value="other" /><label>Other</label>
</tr>
<tr>
<td><label>Data Backup:</label></td>
<input type="checkbox" name=box2[] value="documents" /><label>My Documents</label>
<input type="checkbox" name=box2[] value="pics" /><label>Pictures</label>
<input type="checkbox" name=box2[] value="music" /><label>Music</label>
<input type="checkbox" name=box2[] value="financial" /><label>Financial</label>
<input type="checkbox" name=box2[] value="desktop" /><label>Desktop</label>
<input type="checkbox" name=box2[] value="email" /><label>Third Party Email Client</label>
<input type="checkbox" name=box2[] value="other" /><label>Other</label>
</tr>
</table>
<?php
$result = mysql_query("
INSERT INTO
client
( `client_type`,`comp_type`, `bname`, `pline`, `model`, `os`, `condition`, `ram`, `hdd1` , `passwords` , `issue`, 'power_supply', 'software_discs', 'service', 'dbackup', 'win_update', 'win_update_notes', 'virus_scan', 'virus_scan_notes','browser_clear', 'browser_clear_notes', 'recycle_clear', 'recycle_clear_notes', 'registry', 'registry_notes', 'junk_soft', 'junk_soft_notes', 'ram_recom', 'ram_recom_notes', 'hdd_health', 'hdd_health_notes', 'devmgmt', 'devmgmt_notes', 'free_soft', 'free_soft_notes', 'support_info')
VALUES
(
'".mysql_real_escape_string($client_type)."',
'".mysql_real_escape_string($comp_type)."',
'".mysql_real_escape_string($_REQUEST['brand'])."',
'".mysql_real_escape_string($_REQUEST['line'])."',
'".mysql_real_escape_string($_REQUEST['model'])."',
'".mysql_real_escape_string($_REQUEST['os'])."',
'".mysql_real_escape_string($_REQUEST['condtion'])."',
'".mysql_real_escape_string($_REQUEST['ram'])."',
'".mysql_real_escape_string($_REQUEST['hd1'])."',
'".mysql_real_escape_string($_REQUEST['passwords'])."',
'".mysql_real_escape_string($_REQUEST['issue'])."',
'".mysql_real_escape_string($power_supply)."',
'".mysql_real_escape_string($_REQUEST['software_discs'])."',
)");
$results = mysql_query($result) or die(mysql_error());
?>
