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<?php
$solution = (isset($_POST['solution']) && !empty($_POST['solution'])) ? mysql_escape_string(strip_tags($_POST['solution'])) : "";
$name = (isset($_POST['name']) && !empty($_POST['name'])) ? mysql_escape_string(strip_tags($_POST['name'])) : "";
$email = (isset($_POST['email']) && !empty($_POST['email'])) ? mysql_escape_string(strip_tags($_POST['email'])) : "";
$phone = (isset($_POST['phone']) && !empty($_POST['phone'])) ? mysql_escape_string(strip_tags($_POST['phone'])) : "";
$contact_method = (isset($_POST['contact_method']) && !empty($_POST['contact_method'])) ? mysql_escape_string(strip_tags($_POST['contact_method'])) : "";
$allOK=true;
if("Submit" == strval($_POST["submit"]))
{
if( ""==$solution )
{
$allOK=false;
}
if( ""==$name )
{
$allOK=false;
}
}
if($allOK && "Submit"==strval($_POST["submit"]) )
{
$todayis = date("l, F j Y, g:i a") ;
$subject = "Purchase Page Form";
$message = "
A new message has been received from the Purchase Page.
Contact information:
Solution: $solution
Name: $lname
Email: $email
Company: $phone
Contact Method: $contact_method
";
$from = "From: $email\r\n";
mail("BLOCKED_EMAIL_ADDRESS", $subject, $message, $from);
}
?>
<!--START Top Banner-->
<div id="header">
<?php include 'header_spotlight.php'; ?></div>
<!--END Top Banner-->
<!--START Menu-->
<!--Height must be 30px more then Body height-->
<div style="height:810px;" id="menu">
<?php include 'includes/left_nav.php'; ?>
</div>
<!--END Header-->
<!--START Body-->
<p align="center" class="red_title">
<?php
if(!$allOK)
{
echo("<div class='red_title' align='center'>Please provide all the required fields.</div>");
}
else
{
echo("<div class='red_title' align='center'>Thank you, your message has been sent.</div>");
}
?>
</p>
<div style="background-color:#CCCCCC; width:300px; padding-top:20px; margin-left:auto; margin-right:auto; height:400px;">
<p align="center" class="title bold">Want someone to contact you?</p>
<form id="contact" name="contact" method="post" action="purchase_send.php">
<table align="center" class="body" width="200">
<!--DWLayoutTable-->
<tr>
<td colspan="2"><input type="radio" name="solution" value="auto_truck" id="solution_0" />
Auto & Light Truck</td>
</tr>
<tr>
<td colspan="2"><input type="radio" name="solution" value="owner_operator" id="solution_1" />
Owner / Operator</td>
</tr>
<tr>
<td colspan="2"><input type="radio" name="solution" value="truck_fleet" id="solution_2" />
Truck Fleet</td>
</tr>
<tr>
<td colspan="2"><input type="radio" name="solution" value="heavy_equipment" id="solution_3" />
Heavy Equipment</td>
</tr>
<tr>
<td colspan="2"><p>
<input type="radio" name="solution" value="other" id="solution_3" />
Other</p><br /> </td>
</tr>
<tr>
<td colspan="2" align="right"><div align="left">Name:
<input type="text" name="name" id="name" />
</div></td>
</tr>
<tr>
<td colspan="2" align="right"><div align="left">Phone:
<input type="text" name="phone" id="phone" />
</div></td>
</tr>
<tr>
<td colspan="2" align="right"><div align="left">Email:
<input type="text" name="email" id="email" />
</div></td>
</tr>
<tr>
<td colspan="2" align="right"><div align="left" class="small_body"><br />
<p>How would you prefer to be contacted?</p>
</div> </td>
</tr>
<tr>
<td width="63" height="23" valign="top"><label>
<input type="radio" name="contact_method" value="contact_by_phone" id="contact_method_0" />
Phone</label></td>
<td width="121" rowspan="2" align="right" valign="bottom"><input type="submit" name="button" id="button" value="Submit" /></td>
</tr>
<tr>
<td height="23" valign="top"><label>
<input type="radio" name="contact_method" value="contact_by_email" id="contact_method_1" />
Email</label></td>
</tr>
</table>
</form>
</div>
<!--END Body-->
<?php include 'includes/footer.php'; ?>
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