\/\;\!\|\-\?\%\@\.\#\&\(\)]"," ",$name); if (!ereg('^[-!#$%&\'*+\\./0-9=?A-Z^_`a-z{|}~]+'.'@'.'[-!#$%&\'*+\\/0-9=?A-Z^_`a-z{|}~]+\.'.'[-!#$%&\'*+\\./0-9=?A-Z^_`a-z{|}~]+$', $email)) { $email=""; } $address = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]"," ",$address); $city = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\?\%\@\.\#\&\(\)]"," ",$city); $state = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]"," ",$state); $zip = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\?\%\@\.\#\&\(\)]"," ",$zip); $country = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\?\%\@\.\#\&\(\)]"," ",$country); $telephone = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\?\%\@\#\&]"," ",$telephone); $comments = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]"," ",$comments); if (is_array($interest)) { $interests = implode(", ", $interest); } $interests = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]","",$interests); $timeframe = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]","",$timeframe); if (is_array($addinfo)) { $addinfos = implode(", ", $addinfo); } $addinfos = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]","",$addinfos); $how = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]","",$how); $maillist = eregi_replace("[\$\'\`\"\<\>\/\;\!\|\-\?\%\@\.\#\&\(\)]","",$maillist); // reset error values if ($loopit == "seen") { if ($name == "") { $name_err="!"; $proc = "1"; } if ($email == "") { $email_err="!"; $proc = "1"; } if ($how == "phone") { if (!eregi("^[0-9]? ?\-? ?\(?[0-9]{3}\)?\-? ?[0-9]{3} ?\-? ?[0-9]{4}$",$telephone)) { $telephone_err ="!"; $proc = "1"; $etype="1"; } } if ($how == "usmail") { if ($address =="" || $city == "" || $state == "" || $zip == "" || $country == "") { $proc = "1"; $etype = "2"; if ($address == "") { $address_err="!"; } if ($city == "") { $city_err="!"; } if ($state == "") { $state_err="!"; } if ($zip == "") { $zip_err="!"; } if ($country == "") { $zip_err="!"; } } } } $formblock1 = '
Web Design and Hosting Inquiry
 

'; $formblock2 ='Information submitted via this form will only be used to help us answer your inquiry.
Read our privacy policy for more information.
Want a shorter form? Click Here'; $formblock3 = "
"; // Programs $formblock4 ='"; //contact method $formblock33='
Name: (required) $name_err
Company: (If applicable)
E-mail Address: (required) $email_err
Address: $address_err please include complete address information if you wish us to respond by mail)
City: $city_err
State:$state_err
Zip: $zip_err
Country: $country_err
Contact Telephone #: $telephone_err(please include if you wish us to respond by phone)
You are interested in:
(Check all which apply)		Other questions you may have:
Choose how you prefer to be contacted:
  • Custom Design
  • About Our Hosting Services
  • Other Services
  • Frequently Asked Questions
  • Glossary of Terms
  • Request Information
  • Browse our Web Design Portfolio
    		•
    '; if ($loopit != "seen") { print $formblock1; print $formblock2; print $formblock3; print $formblock4; print $formblock5; print $formblock6; print $formblock7; print $formblock8; print $formblock9; print $formblock10; print $formblock11; print $formblock12; print $formblock13; print $formblock14; print $formblock15; print $formblock16; print $formblock17; print $formblock18; print $formblock19; print $formblock20; print $formblock21; print $formblock22; print $formblock23; print $formblock24; print $formblock25; print $formblock26; print $formblock27; print $formblock28; print $formblock29; print $formblock30; print $formblock31; print $formblock32; print $formblock33; print $formblock34; print $formblock35; print $formblock36; print $formblock37; print $formblock38; print $formblock39; print $formblock40; } if ($loopit == "seen" ) { if ($proc !="1") { print $formblock41; print $formblock45; mail("bgmay@computers-in-design.com", "Long Form Web Inquiry", "Long Form Web Inquiry Name: \t$name Company: \t$firm E-mail: \t$email Address: \t$address City: \t$city State: \t$state Zip: \t$zip Telephone: \t$telephone\n Areas of Interest checked: \t$interests\n Decision Time frame: \t$timeframe\n Additional Information being requested: \t$addinfos\n $comments How to contact: \t$how \n Put on email list?: \t$maillist \n", "From:webinquiryform@computersindesign.com"); } else { print $formblock1; if ($etype == "1") { print $formblock44; } if ($etype == "2") { print $formblock43; } if ($etype =="3") { print $formblock42; } print $formblock3; print $formblock4; if (isset($interest[1])) { print ' checked '; } print $formblock5; if (isset($interest[2])) { print ' checked '; } print $formblock6; if (isset($interest[3])) { print ' checked '; } print $formblock7; if (isset($interest[4])) { print ' checked '; } print $formblock8; if (isset($interest[5])) { print ' checked '; } print $formblock9; if (isset($interest[6])) { print ' checked '; } print $formblock10; if (isset($interest[7])) { print ' checked '; } print $formblock11; if (isset($interest[8])) { print ' checked '; } print $formblock12; print $formblock13; print $formblock14; if ($hosting == "yes") { print ' checked '; } print $formblock15; if ($hosting == "no") { print ' checked '; } print $formblock16; print $formblock17; print $formblock18; if ($domain == "yes") { print ' checked '; } print $formblock19; if ($domain == "no") { print ' checked '; } print $formblock20; print $formblock21; print $formblock22; if ($website == "yes") { print ' checked '; } print $formblock23; if ($website == "no") { print ' checked '; } print $formblock24; print $formblock25; if ($timeframe == "less than 30 days") { print ' checked '; } print $formblock26; if ($timeframe == "30 to 60 days") { print ' checked '; } print $formblock27; if ($timeframe == "not sure") { print ' checked '; } print $formblock28; print $formblock29; if (isset($addinfo[1])) { print ' checked '; } print $formblock30; if (isset($addinfo[2])) { print ' checked '; } print $formblock31; print $formblock32; print $formblock33; if ($how == 'email') { print ' checked '; } print $formblock34; if ($how == 'phone') { print ' checked '; } print $formblock35; if ($how == 'usmail') { print ' checked '; } print $formblock36; print $formblock37; if ($maillist == 'yes') { print ' checked '; } print $formblock38; if ($maillist == 'no') { print (" checked "); } print $formblock39; print $formblock40; } } ?>
     
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    Computers in Design Inc.
    A design technology consulting firm
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    New York, NY 10012
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