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#725085
<script language="javascript"> function Show() { document.getElementById('form1_holder').innerHTML = "Thanks for the request.<br /> We will reply soon." }</script><div id="form1_holder"><form action="#" method="post"><table border='1'> <tr> <td>Name: </td> <td><input type="text" name="name" /></td> <td></td> </tr> <tr> <td>Address: </td> <td><input type="text" name="address" /></td> <td></td> </tr> <tr> <td>Phone: </td> <td><input type="text" name="phone" /></td> <td></td> </tr> <tr> <td>Request: </td> <td><textarea name="request" cols="40" rows="4"></textarea></td> <td></td> </tr> <tr> <td></td> <td colspan"4"><input type="submit" name="submit" value="Submit" /> <input type="reset" value="Reset"></td> </tr></table></form></div><?phpif (isset($_POST['submit'])) { $name = $_POST['name']; $addr = $_POST['address']; $phone = $_POST['phone']; $request = $_POST['request']; $body = " Name: $name <br /> Address: $addr <br /> Phone: $phone <br /> Request: $request"; @ mail('aabrams@mosaictechnologies.com', 'Request', $request); echo '<script language="javascript"> Show() </script>';}