rendered paste body<STRONG>* Please choose a department to contact:</STRONG><br><br><?php if (isset($_REQUEST['success'])) { echo "<font color=red>Your request has been submitted. Please allow upto 24 hours for a reply.</font>"; } ?> <FORM name="contact" onSubmit="return validate_form(this)" action="<?php $PHP_SELF; ?>" method="post"> <table width="100%" border="0" cellspacing="1" cellpadding="3"> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio1" type="radio" CHECKED value="1" name="radio"></td> <td bgcolor="#EEF1F7"><STRONG>General Support </STRONG></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio2" type="radio" value="2" name="radio"></td> <td bgcolor="#EEF1F7"><LABEL><STRONG>Billing </STRONG></LABEL></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio3" type="radio" value="3" name="radio"></td> <td bgcolor="#EEF1F7"><STRONG>Sales</STRONG></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio4" type="radio" value="4" name="radio"></td> <td bgcolor="#EEF1F7"><LABEL><STRONG>Abuse </STRONG></LABEL></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio5" type="radio" value="5" name="radio"></td> <td bgcolor="#EEF1F7"><strong>Dedicated Server Support </strong></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio6" type="radio" value="6" name="radio"></td> <td bgcolor="#EEF1F7"><STRONG>Custom Package </STRONG></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio7" type="radio" value="7" name="radio"></td> <td bgcolor="#EEF1F7"><strong>Web Designs </strong></td> </tr> <tr> <td bgcolor="#EEF1F7"><INPUT id="radio8" type="radio" value="8" name="radio"></td> <td bgcolor="#EEF1F7"><strong>Owner</strong></td> </tr> </table> <table width="100%" border="0" cellspacing="1" cellpadding="3"> <tr> <td bgcolor="#F2F2F2"><STRONG>Username:</STRONG></td> <td bgcolor="#F2F2F2"><INPUT type="text" name="uname">( If already a customer. )</td> </tr> <tr> <td bgcolor="#F2F2F2"><STRONG>Firstname:</STRONG> <span class="style7">*</span></td> <td bgcolor="#F2F2F2"><INPUT type="text" name="firstname"></td> </tr> <tr> <td bgcolor="#F2F2F2"><STRONG>Lastname: </STRONG><STRONG class="style7">*</STRONG> </td> <td bgcolor="#F2F2F2"><INPUT type="text" name="lastname"></td> </tr> <tr> <td bgcolor="#F2F2F2"><STRONG>Email:</STRONG> <STRONG class="style7">*</STRONG> </td> <td bgcolor="#F2F2F2"><INPUT type="text" name="email"></td> </tr> <tr> <td bgcolor="#F2F2F2"><STRONG>Refered By:</STRONG></td> <td bgcolor="#F2F2F2"><INPUT type="text" name="referedby">( If applicable )</td> </tr> </table> <p><STRONG>Message to be sent to selected staff member:</STRONG> <STRONG>*</STRONG> </p> <TEXTAREA name="comments" rows="10" cols="40">Your Comments Here ...</TEXTAREA> <BR> <BR> <INPUT name="submit" type="submit" value="Submit"> <br> <STRONG><br> All fields marked with a <span class="style7">*</span> is required! </STRONG> <br> <BR> </FORM> <?php // Logging if ($_REQUEST['submit']) { if (isset($_SERVER['HTTP_X_FORWARDED_FOR'])) { $ClientIP = $_SERVER['HTTP_X_FORWARDED_FOR']; } else { $ClientIP = $_SERVER['REMOTE_ADDR']; } switch ($_POST['radio']) { case 1: $email_address='support@worxtech.net'; break; case 2: $email_address='billing@worxtech.net'; break; case 3: $email_address='sales@worxtech.net'; break; case 4: $email_address='abuse@worxtech.net'; break; case 5: $email_address='dedicated@worxtech.net'; break; case 6: $email_address='custom@worxtech.net'; break; case 7: $email_address='designs@worxtech.net'; break; case 8: $email_address='admin@worxtech.com'; break; exit(); } $username = $_POST['uname']; $firstname = $_POST['firstname']; $lastname = $_POST['lastname']; $email = $_POST['email']; $referedby = $_POST['referedby']; $comments = $_POST['comments']; if (get_magic_quotes_gpc()) { $username = stripslashes($username); $firstname = stripslashes($firstname); $lastname = stripslashes($lastname); $email = stripslashes($email); $referedby = stripslashes($referedby); $comments = stripslashes($comments); } $Subject = "WorxTech Support Contact Request " . date('m/d/y') . ""; $Subject = preg_replace('/[\x00-\x1F]/', '', $Subject); $From = "$email"; $From = preg_replace('/[\x00-\x1F]/', '', $From); $Body = "" . date('m/d/y') . "<br />" . "<br />" . "<b>Username:</b> $username<br />" . "<b>Firstname:</b> $firstname<br />" . "<b>Lastname:</b> $lastname<br />" . "<b>Email:</b> $email<br />" . "<b>Refered By:</b> $referedby<br />" . "<b>Comments:</b><br />" . "$comments<br />" . "<br />" . "<b>" . $_SERVER['HTTP_USER_AGENT'] . "<br />" . "$ClientIP<br />" . "<br />" . "<br />" . "</b>"; $Header = "From: $From\n" . "Reply-To: $From\n" . "MIME-Version: 1.0\n" . "Content-type: text/html; charset=\"ISO-8859-1\"\n" . "Content-transfer-encoding: 8bit\n"; if(!mail($email_address, $Subject, $Body, $Header)){ echo 'There was an error while trying to process your data. Please contact the admin at admin@worxtech.com.'; } $success = "y"; echo "<font color=red>Your request has been submitted. Please allow upto 24 hours for a reply.</font>"; }?>