Solved

PHP Formmail issue

Posted on 2008-10-30
5
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Last Modified: 2013-12-13
I am trying to get a form to be sent out through my web hosting and they are saying they cant because my domain is registered with another webhosting.  I have Exchange and had to forward my mx records to my exchange server and right now when i submit http://ionfusion.com/contactus.htm.  

Below is my code for my sendmail.php.


For some reason its saying that i don't have a invalid email address.  Is there something i am missing . Does someone have a better php code that will work.

Also since i having my domain hosted elsewhere could that be the problem?
<?

/*

##############################################################################

# PLEASE DO NOT REMOVE THIS HEADER!!!

#

# COPYRIGHT NOTICE

#

# FormMail.php v5.0

# Copyright 2000-2004 Ai Graphics and Joe Lumbroso (c) All rights reserved.

# Created 07/06/2000   Last Modified 10/28/2003

# Joseph Lumbroso, http://www.aigraphics.com, http://www.dtheatre.com

#                  http://www.dtheatre.com/scripts/

##############################################################################

#

# This cannot and will not be inforced but I would appreciate a link back

# to any of these sites:

# http://www.dtheatre.com

# http://www.aigraphics.com

# http://www.dtheatre.com/scripts/

#

# THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR

# IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,

# FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL

# THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR

# OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE,

# ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR

# OTHER DEALINGS IN THE SOFTWARE.

#

##############################################################################

*/
 

// for ultimate security, use this instead of using the form

$recipient = "info@ionfusion.com"; // youremail@domain.com
 

// bcc emails (separate multiples with commas (,))

$bcc = "";
 

// referers.. domains/ips that you will allow forms to

// reside on.

$referers = array ('24.249.215.150','ionfusion.com');
 

// banned emails, these will be email addresses of people

// who are blocked from using the script (requested)

//$banlist = array ('*@somedomain.com', 'user@domain.com', 'etc@domains.com');
 

// field / value seperator

define("SEPARATOR", ($separator)?$separator:": ");
 

// content newline

define("NEWLINE", ($newline)?$newline:"\n");
 

// formmail version (for debugging mostly)

define("VERSION", "5.0");
 
 

// our mighty error function..

function print_error($reason,$type = 0) {

   build_body($title, $bgcolor, $text_color, $link_color, $vlink_color, $alink_color, $style_sheet);

   // for missing required data

   if ($type == "missing") {

      if ($missing_field_redirect) {

         header("Location: $missing_field_redirect?error=$reason");

         exit;

      } else {

      ?>

      The form was not submitted for the following reasons:<p>

      <ul><?

      echo $reason."\n";

      ?></ul>

      Please use your browser's back button to return to the form and try again.<?

      }

   } else { // every other error

      ?>

      The form was not submitted because of the following reasons:<p>

      <?

   }

   echo "<br><br>\n";

   echo "<small>This form is powered by <a href=\"http://www.dtheatre.com/scripts/\">Jack's Formmail.php ".VERSION."</a></small>\n\n";

   exit;

}
 

// function to check the banlist

// suggested by a whole lot of people.. Thanks

function check_banlist($banlist, $email) {

   if (count($banlist)) {

      $allow = true;

      foreach($banlist as $banned) {

         $temp = explode("@", $banned);

         if ($temp[0] == "*") {

            $temp2 = explode("@", $email);

            if (trim(strtolower($temp2[1])) == trim(strtolower($temp[1])))

               $allow = false;

         } else {

            if (trim(strtolower($email)) == trim(strtolower($banned)))

               $allow = false;

         }

      }

   }

   if (!$allow) {

      print_error("You are using from a <b>banned email address.</b>");

   }

}
 

// function to check the referer for security reasons.

// contributed by some one who's name got lost.. Thanks

// goes out to him any way.

function check_referer($referers) {

   if (count($referers)) {

      $found = false;
 

      $temp = explode("/",getenv("HTTP_REFERER"));

      $referer = $temp[2];

      

      if ($referer=="") {$referer = $_SERVER['HTTP_REFERER'];

         list($remove,$stuff)=split('//',$referer,2);

         list($home,$stuff)=split('/',$stuff,2);

         $referer = $home;

      }

      

      for ($x=0; $x < count($referers); $x++) {

         if (eregi ($referers[$x], $referer)) {

            $found = true;

         }

      }

      if ($referer =="")

         $found = false;

      if (!$found){

         print_error("You are coming from an <b>unauthorized domain.</b>");

         error_log("[FormMail.php] Illegal Referer. (".getenv("HTTP_REFERER").")", 0);

      }

         return $found;

      } else {

         return true; // not a good idea, if empty, it will allow it.

   }

}

if ($referers)

   check_referer($referers);
 

if ($banlist)

   check_banlist($banlist, $email);
 

// This function takes the sorts, excludes certain keys and 

// makes a pretty content string.

function parse_form($array, $sort = "") {

   // build reserved keyword array

   $reserved_keys[] = "MAX_FILE_SIZE";

   $reserved_keys[] = "required";

   $reserved_keys[] = "redirect";

   $reserved_keys[] = "require";

   $reserved_keys[] = "path_to_file";

   $reserved_keys[] = "recipient";

   $reserved_keys[] = "subject";

   $reserved_keys[] = "sort";

   $reserved_keys[] = "style_sheet";

   $reserved_keys[] = "bgcolor";

   $reserved_keys[] = "text_color";

   $reserved_keys[] = "link_color";

   $reserved_keys[] = "vlink_color";

   $reserved_keys[] = "alink_color";

   $reserved_keys[] = "title";

   $reserved_keys[] = "missing_fields_redirect";

   $reserved_keys[] = "env_report";

   $reserved_keys[] = "submit";

   if (count($array)) {

      if (is_array($sort)) {

         foreach ($sort as $field) {

            $reserved_violation = 0;

            for ($ri=0; $ri<count($reserved_keys); $ri++)

               if ($array[$field] == $reserved_keys[$ri]) $reserved_violation = 1;
 

            if ($reserved_violation != 1) {

               if (is_array($array[$field])) {

                  for ($z=0;$z<count($array[$field]);$z++)

                     $content .= $field.SEPARATOR.$array[$field][$z].NEWLINE;

               } else

                  $content .= $field.SEPARATOR.$array[$field].NEWLINE;

            }

         }

      }

      while (list($key, $val) = each($array)) {

         $reserved_violation = 0;

         for ($ri=0; $ri<count($reserved_keys); $ri++)

            if ($key == $reserved_keys[$ri]) $reserved_violation = 1;
 

         for ($ri=0; $ri<count($sort); $ri++)

            if ($key == $sort[$ri]) $reserved_violation = 1;
 

         // prepare content

         if ($reserved_violation != 1) {

            if (is_array($val)) {

               for ($z=0;$z<count($val);$z++)

                  $content .= $key.SEPARATOR.$val[$z].NEWLINE;

            } else

               $content .= $key.SEPARATOR.$val.NEWLINE;

         }

      }

   }

   return $content;

}
 

// mail the content we figure out in the following steps

function mail_it($content, $subject, $email, $recipient) {

   global $attachment_chunk, $attachment_name, $attachment_type, $attachment_sent, $bcc;
 

   $ob = "----=_OuterBoundary_000";

   $ib = "----=_InnerBoundery_001";

   

   $headers  = "MIME-Version: 1.0\r\n"; 

   $headers .= "From: ".$email."\n"; 

   $headers .= "To: ".$recipient."\n"; 

   $headers .= "Reply-To: ".$email."\n";

   if ($bcc) $headers .= "Bcc: ".$bcc."\n"; 

   $headers .= "X-Priority: 1\n"; 

   $headers .= "X-Mailer: DT Formmail".VERSION."\n"; 

   $headers .= "Content-Type: multipart/mixed;\n\tboundary=\"".$ob."\"\n";

   

          

   $message  = "This is a multi-part message in MIME format.\n";

   $message .= "\n--".$ob."\n";

   $message .= "Content-Type: multipart/alternative;\n\tboundary=\"".$ib."\"\n\n";

   $message .= "\n--".$ib."\n";

   $message .= "Content-Type: text/plain;\n\tcharset=\"iso-8859-1\"\n";

   $message .= "Content-Transfer-Encoding: quoted-printable\n\n";

   $message .= $content."\n\n";

   $message .= "\n--".$ib."--\n";

   if ($attachment_name && !$attachment_sent) {

      $message .= "\n--".$ob."\n";

      $message .= "Content-Type: $attachment_type;\n\tname=\"".$attachment_name."\"\n";

      $message .= "Content-Transfer-Encoding: base64\n";

      $message .= "Content-Disposition: attachment;\n\tfilename=\"".$attachment_name."\"\n\n";

      $message .= $attachment_chunk;

      $message .= "\n\n";

      $attachment_sent = 1;

   }

   $message .= "\n--".$ob."--\n";

   

   mail($recipient, $subject, $message, $headers);

}
 

// take in the body building arguments and build the body tag for page display

function build_body($title, $bgcolor, $text_color, $link_color, $vlink_color, $alink_color, $style_sheet) {

   if ($style_sheet)

      echo "<LINK rel=STYLESHEET href=\"$style_sheet\" Type=\"text/css\">\n";

   if ($title)

      echo "<title>$title</title>\n";

   if (!$bgcolor)

      $bgcolor = "#FFFFFF";

   if (!$text_color)

      $text_color = "#000000";

   if (!$link_color)

      $link_color = "#0000FF";

   if (!$vlink_color)

      $vlink_color = "#FF0000";

   if (!$alink_color)

      $alink_color = "#000088";

   if ($background)

      $background = "background=\"$background\"";

   echo "<body bgcolor=\"$bgcolor\" text=\"$text_color\" link=\"$link_color\" vlink=\"$vlink_color\" alink=\"$alink_color\" $background>\n\n";

}
 

// check for a recipient email address and check the validity of it

// Thanks to Bradley miller (bradmiller@accesszone.com) for pointing

// out the need for multiple recipient checking and providing the code.

$recipient_in = split(',',$recipient);

for ($i=0;$i<count($recipient_in);$i++) {

   $recipient_to_test = trim($recipient_in[$i]);

   if (!eregi("^[_\\.0-9a-z-]+@([0-9a-z][0-9a-z-]+\\.)+[a-z]{2,6}$", $recipient_to_test)) {

      print_error("<b>I NEED VALID RECIPIENT EMAIL ADDRESS ($recipient_to_test) TO CONTINUE</b>");

   }

}
 

// This is because I originally had it require but too many people

// were used to Matt's Formmail.pl which used required instead.

if ($required)

   $require = $required;

// handle the required fields

if ($require) {

   // seperate at the commas

   $require = ereg_replace( " +", "", $require);

   $required = split(",",$require);

   for ($i=0;$i<count($required);$i++) {

      $string = trim($required[$i]);

      // check if they exsist

      if((!(${$string})) || (!(${$string}))) {

         // if the missing_fields_redirect option is on: redirect them

         if ($missing_fields_redirect) {

            header ("Location: $missing_fields_redirect");

            exit;

         }

         $require;

         $missing_field_list .= "<b>Missing: $required[$i]</b><br>\n";

      }

   }

   // send error to our mighty error function

   if ($missing_field_list)

      print_error($missing_field_list,"missing");

}
 

// check the email fields for validity

if (($email) || ($EMAIL)) {

   $email = trim($email);

   if ($EMAIL) $email = trim($EMAIL);

   if (!eregi("^[_\.0-9a-z-]+@([0-9a-z][0-9a-z-]+\.)+[a-z]{2,6}$", $email))

      print_error("your <b>email address</b> is invalid");

   $EMAIL = $email;

}
 

// check zipcodes for validity

if (($ZIP_CODE) || ($zip_code)) {

   $zip_code = trim($zip_code);

   if ($ZIP_CODE) $zip_code = trim($ZIP_CODE);

   if (!ereg("(^[0-9]{5})-([0-9]{4}$)", trim($zip_code)) && (!ereg("^[a-zA-Z][0-9][a-zA-Z][[:space:]][0-9][a-zA-Z][0-9]$", trim($zip_code))) && (!ereg("(^[0-9]{5})", trim($zip_code))))

      print_error("your <b>zip/postal code</b> is invalid");

}
 

// check phone for validity

if (($PHONE_NO) || ($phone_no)) {

   $phone_no = trim($phone_no);

   if ($PHONE_NO) $phone_no = trim($PHONE_NO);

   if (!ereg("(^(.*)[0-9]{3})(.*)([0-9]{3})(.*)([0-9]{4}$)", $phone_no))

      print_error("your <b>phone number</b> is invalid");

}
 

// check phone for validity

if (($FAX_NO) || ($fax_no)) {

   $fax_no = trim($fax_no);

   if ($FAX_NO) $fax_no = trim($FAX_NO);

   if (!ereg("(^(.*)[0-9]{3})(.*)([0-9]{3})(.*)([0-9]{4}$)", $fax_no))

      print_error("your <b>fax number</b> is invalid");

}
 

// sort alphabetic or prepare an order

if ($sort == "alphabetic") {

   uksort($HTTP_POST_VARS, "strnatcasecmp");

} elseif ((ereg('^order:.*,.*', $sort)) && ($list = explode(',', ereg_replace('^order:', '', $sort)))) {

   $sort = $list;

}

   

// prepare the content

$content = parse_form($HTTP_POST_VARS, $sort);
 

// check for an attachment if there is a file upload it

if ($attachment_name) {

   if ($attachment_size > 0) {

      if (!$attachment_type) $attachment_type =  "application/unknown";

      $content .= "Attached File: ".$attachment_name."\n";

      $fp = fopen($attachment,  "r");

      $attachment_chunk = fread($fp, filesize($attachment));

      $attachment_chunk = base64_encode($attachment_chunk);

      $attachment_chunk = chunk_split($attachment_chunk);

   }

}
 

// check for a file if there is a file upload it

if ($file_name) {

   if ($file_size > 0) {

      if (!ereg("/$", $path_to_file))

         $path_to_file = $path_to_file."/";

      $location = $path_to_file.$file_name;

      if (file_exists($path_to_file.$file_name))

         $location = $path_to_file.rand(1000,3000).".".$file_name;

      copy($file,$location);

      unlink($file);

      $content .= "Uploaded File: ".$location."\n";

   }

}
 

// second file (see manual for instructions on how to add more.)

if ($file2_name) {

   if ($file_size > 0) {

      if (!ereg("/$", $path_to_file))

         $path_to_file = $path_to_file."/";

      $location = $path_to_file.$file2_name;

      if (file_exists($path_to_file.$file2_name))

         $location = $path_to_file.rand(1000,3000).".".$file2_name;

      copy($file2,$location);

      unlink($file2);

      $content .= "Uploaded File: ".$location."\n";

   }

}
 

// if the env_report option is on: get eviromental variables

if ($env_report) {

   $env_report = ereg_replace( " +", "", $env_report);

   $env_reports = split(",",$env_report);

   $content .= "\n------ eviromental variables ------\n";

   for ($i=0;$i<count($env_reports);$i++) {

      $string = trim($env_reports[$i]);

      if ($env_reports[$i] == "REMOTE_HOST")

         $content .= "REMOTE HOST: ".$REMOTE_HOST."\n";

      if ($env_reports[$i] == "REMOTE_USER")

         $content .= "REMOTE USER: ". $REMOTE_USER."\n";

      if ($env_reports[$i] == "REMOTE_ADDR")

         $content .= "REMOTE ADDR: ". $REMOTE_ADDR."\n";

      if ($env_reports[$i] == "HTTP_USER_AGENT")

         $content .= "BROWSER: ". $HTTP_USER_AGENT."\n";

   }

}
 

// send it off

mail_it(stripslashes($content), ($subject)?stripslashes($subject):"Form Submission", $email, $recipient);

if (file_exists($ar_file)) {

   $fd = fopen($ar_file, "rb");

   $ar_message = fread($fd, filesize($ar_file));

   fclose($fd);

   mail_it($ar_message, ($ar_subject)?stripslashes($ar_subject):"RE: Form Submission", ($ar_from)?$ar_from:$recipient, $email);

}
 

// if the redirect option is set: redirect them

if ($redirect) {

   header("Location: $redirect");

   exit;

} else {

   echo "Thank you for your submission\n";

   echo "<br><br>\n";

   echo "<small>This form is powered by <a href=\"http://www.dtheatre.com/scripts/\">Jack's Formmail.php ".VERSION."!</a></small>\n\n";

   exit;

}
 

// <----------    THE END    ----------> //

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Comment
Question by:Jiggens
  • 3
  • 2
5 Comments
 
LVL 6

Expert Comment

by:fourice
ID: 22841356
For some reason your contactpage has about 9 forms, one for each input field. This won't work. You'll need just one form and include all textfields and the submit button in it. Also the php script seems to look for a input type called email and in your contact page it's called EmailAddress.
0
 
LVL 1

Author Comment

by:Jiggens
ID: 22841579
How would i go about fixing this

without messing up my form layout

Could you help me fix my code than?
<!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>

<TITLE>Orthopedic Devices - Disposable Scalpel Surgical Device Manufacturer Company Ion Fusion </TITLE>

<meta name="title" content="Orthopedic Devices - Disposable Scalpel Surgical Device Manufacturer Company Ion Fusion Surgical" />

<META NAME="Keywords" CONTENT="Surgical Device Orthopedic Devices Disposable Scalpel Surgical Device Manufacturer Orthopedic Devices Disposable Scalpel Manufacturer Company Ion Fusion Surgical" />

<META NAME="Description" CONTENT="Surgical Device Company Ion Fusion offers Orthopedic Devices Disposable Scalpel Surgical Device Manufacturer Surgical Scalpel Blades" />

<meta name="robots" content="index, follow " />

<meta name="robots" content="ALL" />

<meta name="document-classification" content="Medical device company" />

<meta name="document-distribution" content="Global" />

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

<link media="all" rel="stylesheet" title="Cascading Stylesheets" href="includes/ionfusion.css" type="text/css" />

<script src="jsfiles/surgical-device.js" type="text/javascript" language="javascript1.2"></script>

<script src="jsfiles/formvalidation.js" type="text/javascript" language="javascript1.2"></script>

<script language="JavaScript">

<!--

function MM_openBrWindow(theURL,winName,features) { //v2.0

  window.open(theURL,winName,features);

}

//-->

</script>

<style type="text/css">

<!--

.style1 {

	font-size: 18px;

	font-weight: bold;

}

.style3 {

	font-size: 18px;

	font-weight: bold;

	color: #D4D0C8;

}

-->

</style>

</head>

<body>

<!-- Top panel Starts here-->

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0" summary="header">

  <tr> 

    <td colspan="2">&nbsp;</td>

  </tr>

  <tr> 

    <td width="453" valign="top"><a href="http://www.ionfusion.com"><img src="images/logo_ionfusion-medical-device.gif" alt="Medical Device Company - Ion Fusion" width="255" height="54" border="0" /></a></td>

    <td width="304" valign="bottom">&nbsp;</td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr> 

    <td width="453"><img src="images/Blade.gif" width="424" height="175" /></td>

    <td width="304"><img src="images/Femaile_Doctor.gif" width="313" height="175" /></td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr>

    <td align="center" bgcolor="#71ACEE"><a href="http://www.ionfusion.com" onmouseover="MM_swapImage('home','','images/btn_home_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_home_up.gif" alt="Surgical Device Company" name="home" border="0" align="middle" id="home" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator" width="34" height="26" align="middle" id="separator1" /><a href="about_us.htm" onmouseover="MM_swapImage('about_us','','images/btn_aboutus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_aboutus_up.gif" alt="Medical Device" name="about_us" border="0" align="middle" id="about_us" /></a><img src="images/separator_navigation.gif" alt="Surgical Scalpel" name="separator2" width="34" height="26" align="middle" id="separator2" /><a href="products.htm" onmouseover="MM_swapImage('products','','images/btn_products_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_products_up.gif" alt="Surgical Scalpel" border="0" align="middle" id="products" /></a><img src="images/separator_navigation.gif" alt="Surgical Blades" name="separator3" width="34" height="26" align="middle" id="separator3" /><a href="technology.htm" onmouseover="MM_swapImage('technology','','images/btn_technology_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_technology_up.gif" alt="Surgical Scalpel" name="technology" border="0" align="middle" id="technology" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator4" width="34" height="26" align="middle" id="separator4" /><a href="regulatory.htm" onmouseover="MM_swapImage('regulatory','','images/btn_regulatory_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_regulatory_up.gif" name="regulatory" border="0" align="middle" id="regulatory" alt="Surgical Supplies" /></a><img src="images/separator_navigation.gif" alt="Medical Company" name="separator5" width="34" height="26" align="middle" id="separator5" /><a href="contactus.htm" onmouseover="MM_swapImage('contact_us','','images/btn_contactus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_contactus_up.gif" name="contact_us" border="0" align="middle" id="contact_us" alt="Large Saw Blades" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator6" width="34" height="26" align="middle" id="separator6" /><a href="sitemap.htm" onmouseover="MM_swapImage('sitemap','','images/btn_sitemap_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_sitemap_up.gif" alt="Medical Company" name="sitemap" border="0" align="middle" id="sitemap" /></a></td>

  </tr>

</table>

<!-- Main Content area Starts here -->

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr bgcolor="#FFFFFF"> 

    <td height="12" colspan="2"></td>

  </tr>

  <tr> 

    <td bgcolor="#FFFFFF">&nbsp;</td>

    <td width="247" bgcolor="#FEA837"><img src="images/hdg_contact.gif" alt="Disposable Scalpel" width="247" height="25" border="0" /></td>

  </tr>

  <tr bgcolor="#FFFFFF"> 

    <td height="12" colspan="2"></td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="1" bgcolor="#6188B0">

  <tr> 

    <td valign="top" bgcolor="#FFFFFF"> 

      <table width="755" border="0" cellspacing="0" cellpadding="0">

        <tr> 

          <td valign="top"> 

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

              <tr> 

                <td width="3%" valign="top"><img src="images/arrow_corner_orange.gif" alt="Disposable Surgical Scalpel Device" width="19" height="17" vspace="3" /></td>

                <td width="97%" valign="top"> 

                  <table width="97%"  border="0" cellspacing="0" cellpadding="0">

                    <tr> 

                      <td width="100%" height="12" bgcolor="#FFFFFF"></td>

                    </tr>

                    <tr> 

                      <td class="contactgray"> 

                        <h2>CONTACT US - <a href="http://www.ionfusion.com">SURGICAL 

                          DEVICE COMPANY</a></h2>

                        <br />

                        <br />

                        <table width="96%" cellspacing="0" cellpadding="5" align="center">

                          <tr> 

                            <td height="32" colspan="6" align="left" valign="top" class="contactgray"> 

                              <hr size="1" noshade />                            </td>

                          </tr>

                          

                          <tr> 

                            <td align="left" class="contactgray" colspan="6" valign="top"><div align="center" class="style1">INFORMATION REQUEST FORM</div></td>

                          </tr>

                          <tr>

                            <td height="23" align="center" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="middle">&nbsp;</td>

                            <td align="center" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr> 

                            <td width="2%" height="32" align="center" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" width="10%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="27%" valign="middle"><strong>

                             

                              <label>First Name</label>

                              :

                            </strong></td>

                            <td align="center" class="contactgray" width="57%" valign="top"><div align="left">

                              <form id="form1" name="form1" method="post" action="">

                                <input type="text" name="FirstName" id="FirstName" />

                              </form>

                              

                              </div></td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="2%">&nbsp;</td>

                          </tr>

                          <tr> 

                            <td align="center" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="10%" valign="top">&nbsp;</td>

                            <td width="27%" align="left" valign="middle" class="contactgray"><strong>

                              <label></label>

                              Last Name:</strong></td>

                            <td align="center" class="contactgray" width="57%" valign="top"><div align="left">

                              <form id="form2" name="form2" method="post" action="">

                                <input type="text" name="LastName" id="LastName" />

                              </form>

                              </div></td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="middle" class="contactgray"><strong>Address:</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="form3" name="form3" method="post" action="">

                              <input name="Address" type="text" id="Address" value="" size="45" />

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong> City:</strong></td>

                            <td align="left" class="contactgray" valign="top"><input type="text" name="City" id="City" /></td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>State:</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="form4" name="form4" method="post" action="">

                              <input name="State" type="text" id="State" size="10" />

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Zip:</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="form5" name="form5" method="post" action="">

                              <input name="ZipCode" type="text" id="ZipCode" size="15" />

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Phone: (xxx) xxx-xxxx</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="form6" name="form6" method="post" action="">

                              <input type="text" name="Phone" id="Phone" />

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Email Address:</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="email" name="email" method="post" action="">

                              <input type="text" name="EmailAddress" id="EmailAddress" />

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Comments:</strong></td>

                            <td align="left" class="contactgray" valign="top"><form id="form8" name="form8" method="post" action="">

                              <textarea name="Comments" id="Comments" cols="45" rows="5"></textarea>

                            </form>                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">

                              <form method="post" enctype="multipart/form-data" action="sendmail.php" />

                              

                              <input type="submit" name="Submit" id="Submit" value="Submit" />

                              

                              <input name="subject" type="hidden" value="Information Inquiry for IonFusion" />

                            <input name="email" type="hidden" value="E-mail of Sender" /></form>                             </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          

                          <tr> 

                            <td align="left" class="contactgray" colspan="6" valign="top"> 

                              <hr size="1" noshade />                            </td>

                          </tr>

                          <tr> 

                            <td align="left" class="contactgray" colspan="6" valign="top"> 

                              <table width="546" border="0" cellspacing="0" cellpadding="0" align="center">

                                <tr align="center"> 

                                  <td class="verdana12black" width="334" align="left" valign="top"> 

                                    <table width="327" border="0" cellspacing="0" cellpadding="0">

                                      <tr> 

                                        <td> 

                                          <h2>Location</h2>                                        </td>

                                      </tr>

                                      <tr> 

                                        <td> 

                                          <hr noshade size="1" />                                        </td>

                                      </tr>

                                      <tr> 

                                        <td class="verdana11normal"> 

                                          <h1>IonFusion Surgical<span class="verdana11regulargray">&#153;</span></h1>

                                          A DIVISION OF MOLECULAR METALLURGY, 

                                            INC.<br />

                                          11649 RIVERSIDE DRIVE, SUITE 139<br />

                                          LAKESIDE, CALIFORNIA 92040-2369<br />

                                          TEL: (619) 596-1785 / 866-IONFUSE 

                                            (466-3873)<br />

                                          FAX: (619) 596-7474<br />

                                          <a href="http://www.ionfusion.com" class="style3">www.ionfusion.com</a>

                                          <p>&nbsp;</p></td>

                                      </tr>

                                      <tr>

                                        <td class="verdana11normal">&nbsp;</td>

                                      </tr>

                                    </table>

                                    <b> </b></td>

                                  <td class="verdana12black" width="212"><a href="javascript:;" onClick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"></a><a href="javascript:;" onclick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"><img src="images/LSMAP.JPG" width="192" height="132" /></a></td>

                                </tr>

                                <tr align="center"> 

                                  <td class="verdana12black" width="334" bgcolor="#FFFFFF" valign="top">&nbsp;</td>

                                  <td class="contactgray" width="212" valign="top"><a href="javascript:;" onClick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"><b>Click 

                                    For Enlarge</b></a></td>

                                </tr>

                            </table>                            </td>

                          </tr>

                          <tr> 

                            <td align="left" class="contactgray" colspan="6" valign="top"> 

                              <hr size="1" noshade />                            </td>

                          </tr>

                          <tr> 

                            <td align="left" class="contactgray" colspan="6" valign="top">&nbsp;</td>

                          </tr>

                        </table>

                        <h1>&nbsp;</h1>

                      </td>

                    </tr>

                    <tr> 

                      <td height="12" bgcolor="#FFFFFF"></td>

                    </tr>

                  </table>

                </td>

              </tr>

            </table>

          </td>

        </tr>

      </table>

    </td>

  </tr>

</table>

<!-- Bottom panel Starts here -->

<table width="757" align="center">

  <tr>

    <td height="12" align="center" bgcolor="#FFFFFF"></td>

  </tr>

  <tr>

    <td align="center" bgcolor="#71ACEE"><a href="http://www.ionfusion.com" onmouseover="MM_swapImage('bhome','','images/btn_home_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_home_up.gif" alt="Medical Device Company" name="bhome" border="0" align="middle" id="bhome" /></a><img src="images/separator_navigation.gif" alt="Surgical device Company" name="separator" width="34" height="26" align="middle" id="separator1" /><a href="about_us.htm" onmouseover="MM_swapImage('babout_us','','images/btn_aboutus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_aboutus_up.gif" name="babout_us" border="0" align="middle" id="babout_us" alt="Surgical Scalpel" /></a><img src="images/separator_navigation.gif" alt="Surgical Device Company" name="separator2" width="34" height="26" align="middle" id="separator2" /><a href="products.htm" onmouseover="MM_swapImage('bproducts','','images/btn_products_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_products_up.gif" name="bproducts" border="0" align="middle" id="bproducts" alt="Surgical Suppliers" /></a><img src="images/separator_navigation.gif" name="separator3" width="34" height="26" align="middle" id="separator3" /><a href="technology.htm" onmouseover="MM_swapImage('btechnology','','images/btn_technology_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_technology_up.gif"  name="btechnology" border="0" align="middle" id="btechnology" alt="Surgical Scalpel" /></a><img src="images/separator_navigation.gif" name="separator4" width="34" height="26" align="middle" id="separator4" /><a href="regulatory.htm" onmouseover="MM_swapImage('bregulatory','','images/btn_regulatory_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_regulatory_up.gif" name="bregulatory" border="0" align="middle" id="bregulatory" /></a><img src="images/separator_navigation.gif" name="separator5" width="34" height="26" align="middle" id="separator5" /><a href="contactus.htm" onmouseover="MM_swapImage('bcontact_us','','images/btn_contactus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_contactus_up.gif" name="bcontact_us" border="0" align="middle" id="bcontact_us" /></a><img src="images/separator_navigation.gif" name="separator6" width="34" height="26" align="middle" id="separator6" /><a href="sitemap.htm" onmouseover="MM_swapImage('bsitemap','','images/btn_sitemap_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_sitemap_up.gif" name="bsitemap" border="0" align="middle" id="bsitemap" /></a></td>

  </tr>

  <tr>

    <td height="40" align="center" bgcolor="#FFFFFF" class="customerservice">Customer Service <br />

      1-866-IONFUSE (466-3873) </td>

  </tr>

  <tr>

    <td height="1" align="center" bgcolor="#D4E6FA"></td>

  </tr>

  <tr>

    <td height="20" align="right" bgcolor="#FFFFFF" class="footer" Title="Medical Device Company"> 

      <div align="left"> 

        <h5 align="center" class="footer">&copy;2005 IonFusion <a href="http://www.ionfusion.com" lass="footer">Surgical 

          Medical Device Manufacturer Company Surgical Scalpel Supplies</a>&nbsp;</h5>

      </div>

    </td>

  </tr>

</table>

</body>

</html>

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0
 
LVL 6

Accepted Solution

by:
fourice earned 500 total points
ID: 22841686
Try this. I removed all the extra forms and renamed the email one.
I hope it works.

<!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>

<TITLE>Orthopedic Devices - Disposable Scalpel Surgical Device Manufacturer Company Ion Fusion </TITLE>

<meta name="title" content="Orthopedic Devices - Disposable Scalpel Surgical Device Manufacturer Company Ion Fusion Surgical" />

<META NAME="Keywords" CONTENT="Surgical Device Orthopedic Devices Disposable Scalpel Surgical Device Manufacturer Orthopedic Devices Disposable Scalpel Manufacturer Company Ion Fusion Surgical" />

<META NAME="Description" CONTENT="Surgical Device Company Ion Fusion offers Orthopedic Devices Disposable Scalpel Surgical Device Manufacturer Surgical Scalpel Blades" />

<meta name="robots" content="index, follow " />

<meta name="robots" content="ALL" />

<meta name="document-classification" content="Medical device company" />

<meta name="document-distribution" content="Global" />

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

<link media="all" rel="stylesheet" title="Cascading Stylesheets" href="includes/ionfusion.css" type="text/css" />

<script src="jsfiles/surgical-device.js" type="text/javascript" language="javascript1.2"></script>

<script src="jsfiles/formvalidation.js" type="text/javascript" language="javascript1.2"></script>

<script language="JavaScript">

<!--

function MM_openBrWindow(theURL,winName,features) { //v2.0

  window.open(theURL,winName,features);

}

//-->

</script>

<style type="text/css">

<!--

.style1 {

	font-size: 18px;

	font-weight: bold;

}

.style3 {

	font-size: 18px;

	font-weight: bold;

	color: #D4D0C8;

}

-->

</style>

</head>

<body>

<!-- Top panel Starts here-->

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0" summary="header">

  <tr>

    <td colspan="2">&nbsp;</td>

  </tr>

  <tr>

    <td width="453" valign="top"><a href="http://www.ionfusion.com"><img src="images/logo_ionfusion-medical-device.gif" alt="Medical Device Company - Ion Fusion" width="255" height="54" border="0" /></a></td>

    <td width="304" valign="bottom">&nbsp;</td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr>

    <td width="453"><img src="images/Blade.gif" width="424" height="175" /></td>

    <td width="304"><img src="images/Femaile_Doctor.gif" width="313" height="175" /></td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr>

    <td align="center" bgcolor="#71ACEE"><a href="http://www.ionfusion.com" onmouseover="MM_swapImage('home','','images/btn_home_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_home_up.gif" alt="Surgical Device Company" name="home" border="0" align="middle" id="home" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator" width="34" height="26" align="middle" id="separator1" /><a href="about_us.htm" onmouseover="MM_swapImage('about_us','','images/btn_aboutus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_aboutus_up.gif" alt="Medical Device" name="about_us" border="0" align="middle" id="about_us" /></a><img src="images/separator_navigation.gif" alt="Surgical Scalpel" name="separator2" width="34" height="26" align="middle" id="separator2" /><a href="products.htm" onmouseover="MM_swapImage('products','','images/btn_products_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_products_up.gif" alt="Surgical Scalpel" border="0" align="middle" id="products" /></a><img src="images/separator_navigation.gif" alt="Surgical Blades" name="separator3" width="34" height="26" align="middle" id="separator3" /><a href="technology.htm" onmouseover="MM_swapImage('technology','','images/btn_technology_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_technology_up.gif" alt="Surgical Scalpel" name="technology" border="0" align="middle" id="technology" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator4" width="34" height="26" align="middle" id="separator4" /><a href="regulatory.htm" onmouseover="MM_swapImage('regulatory','','images/btn_regulatory_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_regulatory_up.gif" name="regulatory" border="0" align="middle" id="regulatory" alt="Surgical Supplies" /></a><img src="images/separator_navigation.gif" alt="Medical Company" name="separator5" width="34" height="26" align="middle" id="separator5" /><a href="contactus.htm" onmouseover="MM_swapImage('contact_us','','images/btn_contactus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_contactus_up.gif" name="contact_us" border="0" align="middle" id="contact_us" alt="Large Saw Blades" /></a><img src="images/separator_navigation.gif" alt="Medical Device Company" name="separator6" width="34" height="26" align="middle" id="separator6" /><a href="sitemap.htm" onmouseover="MM_swapImage('sitemap','','images/btn_sitemap_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_sitemap_up.gif" alt="Medical Company" name="sitemap" border="0" align="middle" id="sitemap" /></a></td>

  </tr>

</table>

<!-- Main Content area Starts here -->

<table width="757" border="0" align="center" cellpadding="0" cellspacing="0">

  <tr bgcolor="#FFFFFF">

    <td height="12" colspan="2"></td>

  </tr>

  <tr>

    <td bgcolor="#FFFFFF">&nbsp;</td>

    <td width="247" bgcolor="#FEA837"><img src="images/hdg_contact.gif" alt="Disposable Scalpel" width="247" height="25" border="0" /></td>

  </tr>

  <tr bgcolor="#FFFFFF">

    <td height="12" colspan="2"></td>

  </tr>

</table>

<table width="757" border="0" align="center" cellpadding="0" cellspacing="1" bgcolor="#6188B0">

  <tr>

    <td valign="top" bgcolor="#FFFFFF">

      <table width="755" border="0" cellspacing="0" cellpadding="0">

        <tr>

          <td valign="top">

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

              <tr>

                <td width="3%" valign="top"><img src="images/arrow_corner_orange.gif" alt="Disposable Surgical Scalpel Device" width="19" height="17" vspace="3" /></td>

                <td width="97%" valign="top">

                  <table width="97%"  border="0" cellspacing="0" cellpadding="0">

                    <tr>

                      <td width="100%" height="12" bgcolor="#FFFFFF"></td>

                    </tr>

                    <tr>

                      <td class="contactgray">

                      	<form id="form1" name="form1" method="post" action="./sendmail.php">

                        <h2>CONTACT US - <a href="http://www.ionfusion.com">SURGICAL DEVICE COMPANY</a></h2>

                        <br />

                        <br />

                        <table width="96%" cellspacing="0" cellpadding="5" align="center">

                          <tr>

                            <td height="32" colspan="6" align="left" valign="top" class="contactgray">

                              <hr size="1" noshade />                            </td>

                          </tr>
 

                          <tr>

                            <td align="left" class="contactgray" colspan="6" valign="top"><div align="center" class="style1">INFORMATION REQUEST FORM</div></td>

                          </tr>

                          <tr>

                            <td height="23" align="center" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="middle">&nbsp;</td>

                            <td align="center" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td width="2%" height="32" align="center" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" width="10%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="27%" valign="middle"><strong>
 

                              <label>First Name</label>

                              :

                            </strong></td>

                            <td align="center" class="contactgray" width="57%" valign="top"><div align="left">

                                <input type="text" name="FirstName" id="FirstName" />

                              </div></td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="2%">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="center" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="10%" valign="top">&nbsp;</td>

                            <td width="27%" align="left" valign="middle" class="contactgray"><strong>

                              <label></label>

                              Last Name:</strong></td>

                            <td align="center" class="contactgray" width="57%" valign="top"><div align="left">

                                <input type="text" name="LastName" id="LastName" />

                              </div></td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" width="2%" valign="top">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="middle" class="contactgray"><strong>Address:</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <input name="Address" type="text" id="Address" value="" size="45" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong> City:</strong></td>

                            <td align="left" class="contactgray" valign="top"><input type="text" name="City" id="City" /></td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>State:</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <input name="State" type="text" id="State" size="10" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Zip:</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <input name="ZipCode" type="text" id="ZipCode" size="15" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Phone: (xxx) xxx-xxxx</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <input type="text" name="Phone" id="Phone" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Email Address:</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <input type="text" name="email" id="email" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray"><strong>Comments:</strong></td>

                            <td align="left" class="contactgray" valign="top">

                              <textarea name="Comments" id="Comments" cols="45" rows="5"></textarea>

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" valign="top" class="contactgray">&nbsp;</td>

                            <td align="left" class="contactgray" valign="top">

                              <input type="submit" name="Submit" id="Submit" value="Submit" />

															<input name="subject" type="hidden" value="Information Inquiry for IonFusion" />

                            </td>

                            <td align="left" class="contactgray" valign="top">&nbsp;</td>

                            <td align="left" class="contactgray">&nbsp;</td>

                          </tr>
 

                          <tr>

                            <td align="left" class="contactgray" colspan="6" valign="top">

                              <hr size="1" noshade />                            </td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" colspan="6" valign="top">

                              <table width="546" border="0" cellspacing="0" cellpadding="0" align="center">

                                <tr align="center">

                                  <td class="verdana12black" width="334" align="left" valign="top">

                                    <table width="327" border="0" cellspacing="0" cellpadding="0">

                                      <tr>

                                        <td>

                                          <h2>Location</h2>                                        </td>

                                      </tr>

                                      <tr>

                                        <td>

                                          <hr noshade size="1" />                                        </td>

                                      </tr>

                                      <tr>

                                        <td class="verdana11normal">

                                          <h1>IonFusion Surgical<span class="verdana11regulargray">&#153;</span></h1>

                                          A DIVISION OF MOLECULAR METALLURGY,

                                            INC.<br />

                                          11649 RIVERSIDE DRIVE, SUITE 139<br />

                                          LAKESIDE, CALIFORNIA 92040-2369<br />

                                          TEL: (619) 596-1785 / 866-IONFUSE

                                            (466-3873)<br />

                                          FAX: (619) 596-7474<br />

                                          <a href="http://www.ionfusion.com" class="style3">www.ionfusion.com</a>

                                          <p>&nbsp;</p></td>

                                      </tr>

                                      <tr>

                                        <td class="verdana11normal">&nbsp;</td>

                                      </tr>

                                    </table>

                                    <b> </b></td>

                                  <td class="verdana12black" width="212"><a href="javascript:;" onClick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"></a><a href="javascript:;" onclick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"><img src="images/LSMAP.JPG" width="192" height="132" /></a></td>

                                </tr>

                                <tr align="center">

                                  <td class="verdana12black" width="334" bgcolor="#FFFFFF" valign="top">&nbsp;</td>

                                  <td class="contactgray" width="212" valign="top"><a href="javascript:;" onClick="MM_openBrWindow('pup_up.htm','pupup','scrollbars=yes,width=500,height=345')"><b>Click

                                    For Enlarge</b></a></td>

                                </tr>

                            </table>                            </td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" colspan="6" valign="top">

                              <hr size="1" noshade />                            </td>

                          </tr>

                          <tr>

                            <td align="left" class="contactgray" colspan="6" valign="top">&nbsp;</td>

                          </tr>

                        </table>

                        <h1>&nbsp;</h1>

                        </form>

                      </td>

                    </tr>

                    <tr>

                      <td height="12" bgcolor="#FFFFFF"></td>

                    </tr>

                  </table>

                </td>

              </tr>

            </table>

          </td>

        </tr>

      </table>

    </td>

  </tr>

</table>

<!-- Bottom panel Starts here -->

<table width="757" align="center">

  <tr>

    <td height="12" align="center" bgcolor="#FFFFFF"></td>

  </tr>

  <tr>

    <td align="center" bgcolor="#71ACEE"><a href="http://www.ionfusion.com" onmouseover="MM_swapImage('bhome','','images/btn_home_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_home_up.gif" alt="Medical Device Company" name="bhome" border="0" align="middle" id="bhome" /></a><img src="images/separator_navigation.gif" alt="Surgical device Company" name="separator" width="34" height="26" align="middle" id="separator1" /><a href="about_us.htm" onmouseover="MM_swapImage('babout_us','','images/btn_aboutus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_aboutus_up.gif" name="babout_us" border="0" align="middle" id="babout_us" alt="Surgical Scalpel" /></a><img src="images/separator_navigation.gif" alt="Surgical Device Company" name="separator2" width="34" height="26" align="middle" id="separator2" /><a href="products.htm" onmouseover="MM_swapImage('bproducts','','images/btn_products_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_products_up.gif" name="bproducts" border="0" align="middle" id="bproducts" alt="Surgical Suppliers" /></a><img src="images/separator_navigation.gif" name="separator3" width="34" height="26" align="middle" id="separator3" /><a href="technology.htm" onmouseover="MM_swapImage('btechnology','','images/btn_technology_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_technology_up.gif"  name="btechnology" border="0" align="middle" id="btechnology" alt="Surgical Scalpel" /></a><img src="images/separator_navigation.gif" name="separator4" width="34" height="26" align="middle" id="separator4" /><a href="regulatory.htm" onmouseover="MM_swapImage('bregulatory','','images/btn_regulatory_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_regulatory_up.gif" name="bregulatory" border="0" align="middle" id="bregulatory" /></a><img src="images/separator_navigation.gif" name="separator5" width="34" height="26" align="middle" id="separator5" /><a href="contactus.htm" onmouseover="MM_swapImage('bcontact_us','','images/btn_contactus_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_contactus_up.gif" name="bcontact_us" border="0" align="middle" id="bcontact_us" /></a><img src="images/separator_navigation.gif" name="separator6" width="34" height="26" align="middle" id="separator6" /><a href="sitemap.htm" onmouseover="MM_swapImage('bsitemap','','images/btn_sitemap_dn.gif',1)" onmouseout="MM_swapImgRestore()"><img src="images/btn_sitemap_up.gif" name="bsitemap" border="0" align="middle" id="bsitemap" /></a></td>

  </tr>

  <tr>

    <td height="40" align="center" bgcolor="#FFFFFF" class="customerservice">Customer Service <br />

      1-866-IONFUSE (466-3873) </td>

  </tr>

  <tr>

    <td height="1" align="center" bgcolor="#D4E6FA"></td>

  </tr>

  <tr>

    <td height="20" align="right" bgcolor="#FFFFFF" class="footer" Title="Medical Device Company">

      <div align="left">

        <h5 align="center" class="footer">&copy;2005 IonFusion <a href="http://www.ionfusion.com" lass="footer">Surgical

          Medical Device Manufacturer Company Surgical Scalpel Supplies</a>&nbsp;</h5>

      </div>

    </td>

  </tr>

</table>

</body>

</html>

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0
 
LVL 1

Author Comment

by:Jiggens
ID: 22842214
That worked great for the form, but its not sending out.
0
 
LVL 1

Author Comment

by:Jiggens
ID: 22842879
any ideas anyone?
0

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