/*******************************************
Contact form
Version: 1.0
Created: 11/10/2003 (DD/MM/YYYY)
Last Modified: 12/10/2003 (DD/MM/YYYY) (AN)
*******************************************/
if(!session_id()) session_start();
header("Expires: Mon, 1 Jan 1970 01:00:00 GMT");
require 'php2/lib/base2.php';
if(!empty($_GET)) extract($_GET);
if(!empty($_POST)) extract($_POST);
if($reset_sequence){
reset_counter_value();
echo "Counter reset";
exit();
}
if($validate){
$alert = '';
// -- START data set block --
$form_data[firstname] = clean_input($firstname);
$form_data[email] = clean_input($email);
$form_data[address] = clean_input($address);
$form_data[postcode] = clean_email($postcode);
$form_data[suburb] = clean_input($suburb);
$form_data[city] = clean_input($city);
$form_data[phone] = clean_input($phone);
$form_data[brochure] = clean_input($brochure);
$form_data[comment] = clean_input($comment);
if(invalid_input($form_data[firstname]))
$alert .= 'Please enter your Name.
';
if(invalid_input($form_data[phone]))
$alert .= 'Please enter a valid Phone.
';
if(invalid_email($form_data[email]))
$alert .= 'Please enter a valid Email Address.
';
if(strtoupper($_POST['captcha']) != strtoupper($_SESSION['secCode'])) {
$alert .= '
Letters from captcha have not been entered correctly.
'; } else { // security code is valid; reset it! $_SESSION['secCode'] = rand(100000, 999999); // echo "correct code"; } if(empty($alert)){ $message .= "---------------------------------------\n"; $message .= " Cataract Eye Surgery Enquiry Form Submission: $seq_number\n"; $message .= "---------------------------------------\n\n"; $message .= "\nName : ". $form_data[firstname]; $message .= "\nEmail: ". $form_data[email]; $message .= "\nAddress: ". $form_data[address]; $message .= "\nPostcode: ". $form_data[postcode]; $message .= "\nSuburb : ". $form_data[suburb]; $message .= "\nCity : ". $form_data[city]; $message .= "\nPhone : ". $form_data[phone]; $message .= "\nSend Brochure? : ". $form_data[brochure]; $message .= "\nComments: ". $form_data[comment]; $message .= "\n\n----------------END of MESSAGE-----------------------"; if(empty($form_data[email])) $form_data[email] = DEFAULT_EMAIL_ADDRESS; $seq_number = get_counter_value(); $message = preg_replace("/__SEQ_NUMBER__/", $seq_number, $message); // send email to mailing list admin mail(CONTACT_FORM_ADMIN_EMAIL, SITE_URL." Cataract Eye Surgery Enquiry Form - #".$seq_number, $message, "From: ".$form_data[email]); // save data $form_data[seq_number] = $seq_number; $form_data[comment] = preg_replace('/, $/', '', $form_data[comment]); $form_data[comment] = preg_replace("/\n/", ' ', $form_data[comment]); $form_data[comment] = preg_replace("/\r/", ' ', $form_data[comment]); save_data($form_data); $msg = 'Thank you for your enquiry. We will contact you shortly.
The reference number is: #'.$seq_number.'
'; unset($form_data); } } ?>