I don't usually like to do this, but I need help. I have gone over this code
and cannot figure out why it doesn't work. First of all it doesn't check to
see if you have filled in the required fields. Second, it doesn't submit the
information (it's supposed to send it to mySql and email it to me.) and
lastly, it doesn't bring up the thankyou.php after submitting the form. I
don't know enough about PHP to find the problem. If someone could look over
the code and just let me know what I need to do to make it work I would
greatly appreciate it.
Thanks, Here's the code
CODE
<?
if($submit) {
if (!strlen($In1))
$missinginfo='t rue';
if (!strlen($In4))
$missinginfo='t rue';
if (!strlen($In5))
$missinginfo='t rue';
if (!strlen($In6))
$missinginfo='t rue';
if (!strlen($In7))
$missinginfo='t rue';
if (!strlen($state 1))
$missinginfo='t rue';
if (!strlen($In8))
$missinginfo='t rue';
if (!strlen($In9))
$missinginfo='t rue';
if (!strlen($In10) )
$missinginfo='t rue';
if (!strlen($state 2))
$missinginfo='t rue';
if (!strlen($In11) )
$missinginfo='t rue';
if (!strlen($In12) )
$missinginfo='t rue';
//I need to parse the text right here!!!
//This enters the data into the DB
if(!strlen($mis singinfo)){
$sql = "INSERT into customers
(FacilityName,O rderBefore,CID, Name,Dept,Shipp ingAddress,Ship pingCity,State1 ,
Zip,BillingAddr ess,BillingCity ,State2,Billing Zip,Phone,Phone Ext,Fax,Video,V i
deo2,PONumber)
VALUES
('$In1','$In2', '$In3','$In4',' $In5','$In6','$ In7','$state1', '$In8','$In9',' $
In10','$state2' ,'$In11','$In12 ','$In13','$In1 4','$In15','$In 16','$In17')";
if($db = mysql_query($sq l));
//echo 'The following nformation was inserted into the
DB<br>';
//echo
"'$In1','$In2', '$In3','$In4',' $In5','$In6','$ state1','$In7', '$In8','$In9',' $
In10','$state2' ,'$In11','$In12 ','$In13','$In1 4','$In15','$In 16','$In17'";
require('thanky ou.php');
}
?>
<table width="100%" height="100%" border="0" cellspacing="0"
cellpadding="0" >
<tr>
<td height="17"><im g src="images/PreviewHead.jpg " width="313"
height="17"></td>
</tr>
<tr>
<td valign="top" align="left">
<?
if(strlen($miss inginfo))
echo "<br><font color=\"red\">< b>You're missing some required
information.</b></font>";
?>
<br>
<form action="<? $PHP_SELF ?>?mode=preview " method="POST">
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Ord er
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 )) echo
'color="red"'; ?> >Facility name *</font></p></td>
<td width="460"><in put type="text" name="In1" size="80" value="<?
echo $In1 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Have you ordered from us
before?</font></p></td>
<td width="460"><in put type="checkbox" name="In2" value="1"><font
size="0"><i>
Yes </i></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">CID</font></p></td>
<td width="460"><in put type="text" name="In3" size="20" value="<?
echo $In3 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In4 )) echo
'color="red"'; ?> > Your Name*</font></td>
<td width="460">
<input type="text" name="In4" size="40" value="<? echo $In4
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In5 )) echo
'color="red"'; ?> > Department*</font></td>
<td width="460">
<input type="text" name="In5" size="40" value="<? echo $In5
?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 2)) echo
'color="red"'; ?> >Phone Number *</font></td>
<td width="460">
<input type="text" name="In12" size="20" maxlength="12" value="<?
echo $In12 ?>">
<font size="0"> (i.e. 000-000-0000) Extension</font>
<input type="text" name="In13" size="8" maxlength="6"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Fax Number</font></td>
<td width="460"> <font size="0">
<input type="text" name="In14" size="20" maxlength="12" value="<?
echo $In14 ?>">
(i.e. 000-000-0000)</font></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Shi pping
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In6 )) echo
'color="red"'; ?> >Shipping Address*</font></p></td>
<td width="460">
<p>
<input type="text" name="In6" size="80" value="<? echo $In6
?>">
</p></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In7 )) echo
'color="red"'; ?> >City *</font></td>
<td width="460">
<input type="text" name="In7" size="40" value="<? echo $In7
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($sta te1)) echo
'color="red"'; ?> >State*</font></td>
<td width="460">
<select name="state1">
<option selected value="<? echo $state1 ?>"><? echo $state1
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In8 )) echo
'color="red"'; ?> >Zip Code*</font></td>
<td width="460">
<input type="text" name="In8" size="12" maxlength="10" value="<?
echo $In8 ?>"> </td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Bil ling
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In9 )) echo
'color="red"'; ?> >Billing Address*</font></td>
<td width="460">
<input type="text" name="In9" size="80" value="<? echo $In9 ?>">
</td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 0)) echo
'color="red"'; ?> >City*</font></td>
<td width="460">
<input type="text" name="In10" size="40" value="<? echo $In10
?>"> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($sta te2)) echo
'color="red"'; ?> >State*</font></td>
<td width="460">
<select name="state2">
<option selected value="<? echo $state2 ?>"><? echo $state2
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 1)) echo
'color="red"'; ?> >Zip Code*</font></td>
<td width="460">
<input type="text" name="In11" size="12" maxlength="10" value="<?
echo $In11 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt
size="0"><b>Pur chase/Preview:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Video</font></td>
<td width="460">
<select size="1" name="In15">
<option selected><? echo $In15 ?></option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" >Second Video</font></td>
<td width="460"> <select size="1" name="In16">
<option selected><? echo $In16 ?></option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Purcha se Order Number</font></td>
<td width="460">
<input type="text" name="In17" size="40"> </td>
</tr>
<tr valign="middle" bgcolor="<? echo $color1 ?>">
<td align="center" colspan="2"><p style="line-height: 100%;
word-spacing: 0; margin-top: 0; margin-bottom: 0">
<input type="submit" value="Submit" name="submit">
<input type="reset" value="Reset" name="reset">
</td>
</tr>
</table>
</form>
</td>
</tr>
<tr>
<td height="17" align="right" valign="middle" ><img
src="images/BaseLine.jpg" width="329" height="27"></td>
</tr>
<tr>
<td height="100%" valign="bottom" align="center">
<?
include("bottom links.php");
?>
</td>
</tr>
</table>
<?
} else {
?>
<table width="100%" height="100%" border="0" cellspacing="0"
cellpadding="0" >
<tr>
<td height="17"><im g src="images/PreviewHead.jpg " width="313"
height="17"></td>
</tr>
<tr>
<td valign="top" align="left">
<form action="<? $PHP_SELF ?>?mode=preview " method="POST">
<p> </p>
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Ord er
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Facili ty name *</font></p></td>
<td width="460"><in put type="text" name="In1" size="80" value="<?
echo $In1 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Have you ordered from us
before?</font></p></td>
<td width="460"><in put type="checkbox" name="In2" value="1"><font
size="0"><i>
Yes </i></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">CID</font></p></td>
<td width="460"><in put type="text" name="In3" size="20" value="<?
echo $In3 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0"> Your Name*</font></td>
<td width="460">
<input type="text" name="In4" size="40" value="<? echo $In4
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0"> Deptartment*</font></td>
<td width="460">
<input type="text" name="In5" size="40" value="<? echo $In5
?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Phone Number *</font></td>
<td width="460">
<input type="text" name="In12" size="20" maxlength="12" value="<?
echo $In12 ?>">
<font size="0"> (i.e. 000-000-0000) Extension</font>
<input type="text" name="In13" size="8" maxlength="6"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Fax Number</font></td>
<td width="460"> <font size="0">
<input type="text" name="In14" size="20" maxlength="12" value="<?
echo $In14 ?>">
(i.e. 000-000-0000)</font></td>
</tr>
</table><br><p>
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Shi pping
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Shippi ng Address*</font></p></td>
<td width="460">
<p>
<input type="text" name="In6" size="80" value="<? echo $In6
?>">
</p></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">City *</font></td>
<td width="460">
<input type="text" name="In7" size="40" value="<? echo $In7
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">State* </font></td>
<td width="460">
<select name="state1">
<option selected value="<? echo $state1 ?>"><? echo $state1
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Zip Code*</font></td>
<td width="460">
<input type="text" name="In8" size="12" maxlength="10" value="<?
echo $In8 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Bil ling
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Billin g Address*</font></td>
<td width="460">
<input type="text" name="In9" size="80" value="<? echo $In9 ?>">
</td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">City*</font></td>
<td width="460">
<input type="text" name="In10" size="40" value="<? echo $In10
?>"> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">State* </font></td>
<td width="460">
<select name="state2">
<option selected value="<? echo $state2 ?>"><? echo $state2
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Zip Code*</font></td>
<td width="460">
<input type="text" name="In11" size="12" maxlength="10" value="<?
echo $In11 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt
size="0"><b>Pre view/Purchase:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Video</font></td>
<td width="460">
<select size="1" name="In15">
<option selected>(None) </option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Second Video</font></td>
<td width="460"> <select size="1" name="In16">
<option selected>(None) </option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Purcha se Order Number</font></td>
<td width="460">
<input type="text" name="In17" size="40"> </td>
</tr>
<tr valign="middle" bgcolor="<? echo $color1 ?>">
<td align="center" colspan="2"><p style="line-height: 100%;
word-spacing: 0; margin-top: 0; margin-bottom: 0">
<input type="submit" value="Submit" name="submit">
<input type="reset" value="Reset" name="reset">
</td>
</tr>
</table>
</form>
</td>
</tr>
<tr>
<td height="17" align="right" valign="middle" ><img
src="images/BaseLine.jpg" width="329" height="27"></td>
</tr>
<tr>
<td height="100%" valign="bottom" align="center">
<?
include("bottom links.php");
?>
</td>
</tr>
</table>
<?
}
?>
and cannot figure out why it doesn't work. First of all it doesn't check to
see if you have filled in the required fields. Second, it doesn't submit the
information (it's supposed to send it to mySql and email it to me.) and
lastly, it doesn't bring up the thankyou.php after submitting the form. I
don't know enough about PHP to find the problem. If someone could look over
the code and just let me know what I need to do to make it work I would
greatly appreciate it.
Thanks, Here's the code
CODE
<?
if($submit) {
if (!strlen($In1))
$missinginfo='t rue';
if (!strlen($In4))
$missinginfo='t rue';
if (!strlen($In5))
$missinginfo='t rue';
if (!strlen($In6))
$missinginfo='t rue';
if (!strlen($In7))
$missinginfo='t rue';
if (!strlen($state 1))
$missinginfo='t rue';
if (!strlen($In8))
$missinginfo='t rue';
if (!strlen($In9))
$missinginfo='t rue';
if (!strlen($In10) )
$missinginfo='t rue';
if (!strlen($state 2))
$missinginfo='t rue';
if (!strlen($In11) )
$missinginfo='t rue';
if (!strlen($In12) )
$missinginfo='t rue';
//I need to parse the text right here!!!
//This enters the data into the DB
if(!strlen($mis singinfo)){
$sql = "INSERT into customers
(FacilityName,O rderBefore,CID, Name,Dept,Shipp ingAddress,Ship pingCity,State1 ,
Zip,BillingAddr ess,BillingCity ,State2,Billing Zip,Phone,Phone Ext,Fax,Video,V i
deo2,PONumber)
VALUES
('$In1','$In2', '$In3','$In4',' $In5','$In6','$ In7','$state1', '$In8','$In9',' $
In10','$state2' ,'$In11','$In12 ','$In13','$In1 4','$In15','$In 16','$In17')";
if($db = mysql_query($sq l));
//echo 'The following nformation was inserted into the
DB<br>';
//echo
"'$In1','$In2', '$In3','$In4',' $In5','$In6','$ state1','$In7', '$In8','$In9',' $
In10','$state2' ,'$In11','$In12 ','$In13','$In1 4','$In15','$In 16','$In17'";
require('thanky ou.php');
}
?>
<table width="100%" height="100%" border="0" cellspacing="0"
cellpadding="0" >
<tr>
<td height="17"><im g src="images/PreviewHead.jpg " width="313"
height="17"></td>
</tr>
<tr>
<td valign="top" align="left">
<?
if(strlen($miss inginfo))
echo "<br><font color=\"red\">< b>You're missing some required
information.</b></font>";
?>
<br>
<form action="<? $PHP_SELF ?>?mode=preview " method="POST">
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Ord er
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 )) echo
'color="red"'; ?> >Facility name *</font></p></td>
<td width="460"><in put type="text" name="In1" size="80" value="<?
echo $In1 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Have you ordered from us
before?</font></p></td>
<td width="460"><in put type="checkbox" name="In2" value="1"><font
size="0"><i>
Yes </i></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">CID</font></p></td>
<td width="460"><in put type="text" name="In3" size="20" value="<?
echo $In3 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In4 )) echo
'color="red"'; ?> > Your Name*</font></td>
<td width="460">
<input type="text" name="In4" size="40" value="<? echo $In4
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In5 )) echo
'color="red"'; ?> > Department*</font></td>
<td width="460">
<input type="text" name="In5" size="40" value="<? echo $In5
?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 2)) echo
'color="red"'; ?> >Phone Number *</font></td>
<td width="460">
<input type="text" name="In12" size="20" maxlength="12" value="<?
echo $In12 ?>">
<font size="0"> (i.e. 000-000-0000) Extension</font>
<input type="text" name="In13" size="8" maxlength="6"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Fax Number</font></td>
<td width="460"> <font size="0">
<input type="text" name="In14" size="20" maxlength="12" value="<?
echo $In14 ?>">
(i.e. 000-000-0000)</font></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Shi pping
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In6 )) echo
'color="red"'; ?> >Shipping Address*</font></p></td>
<td width="460">
<p>
<input type="text" name="In6" size="80" value="<? echo $In6
?>">
</p></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In7 )) echo
'color="red"'; ?> >City *</font></td>
<td width="460">
<input type="text" name="In7" size="40" value="<? echo $In7
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($sta te1)) echo
'color="red"'; ?> >State*</font></td>
<td width="460">
<select name="state1">
<option selected value="<? echo $state1 ?>"><? echo $state1
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In8 )) echo
'color="red"'; ?> >Zip Code*</font></td>
<td width="460">
<input type="text" name="In8" size="12" maxlength="10" value="<?
echo $In8 ?>"> </td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Bil ling
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In9 )) echo
'color="red"'; ?> >Billing Address*</font></td>
<td width="460">
<input type="text" name="In9" size="80" value="<? echo $In9 ?>">
</td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 0)) echo
'color="red"'; ?> >City*</font></td>
<td width="460">
<input type="text" name="In10" size="40" value="<? echo $In10
?>"> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($sta te2)) echo
'color="red"'; ?> >State*</font></td>
<td width="460">
<select name="state2">
<option selected value="<? echo $state2 ?>"><? echo $state2
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0" <? if(!strlen($In1 1)) echo
'color="red"'; ?> >Zip Code*</font></td>
<td width="460">
<input type="text" name="In11" size="12" maxlength="10" value="<?
echo $In11 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt
size="0"><b>Pur chase/Preview:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Video</font></td>
<td width="460">
<select size="1" name="In15">
<option selected><? echo $In15 ?></option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0" >Second Video</font></td>
<td width="460"> <select size="1" name="In16">
<option selected><? echo $In16 ?></option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Purcha se Order Number</font></td>
<td width="460">
<input type="text" name="In17" size="40"> </td>
</tr>
<tr valign="middle" bgcolor="<? echo $color1 ?>">
<td align="center" colspan="2"><p style="line-height: 100%;
word-spacing: 0; margin-top: 0; margin-bottom: 0">
<input type="submit" value="Submit" name="submit">
<input type="reset" value="Reset" name="reset">
</td>
</tr>
</table>
</form>
</td>
</tr>
<tr>
<td height="17" align="right" valign="middle" ><img
src="images/BaseLine.jpg" width="329" height="27"></td>
</tr>
<tr>
<td height="100%" valign="bottom" align="center">
<?
include("bottom links.php");
?>
</td>
</tr>
</table>
<?
} else {
?>
<table width="100%" height="100%" border="0" cellspacing="0"
cellpadding="0" >
<tr>
<td height="17"><im g src="images/PreviewHead.jpg " width="313"
height="17"></td>
</tr>
<tr>
<td valign="top" align="left">
<form action="<? $PHP_SELF ?>?mode=preview " method="POST">
<p> </p>
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Ord er
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Facili ty name *</font></p></td>
<td width="460"><in put type="text" name="In1" size="80" value="<?
echo $In1 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Have you ordered from us
before?</font></p></td>
<td width="460"><in put type="checkbox" name="In2" value="1"><font
size="0"><i>
Yes </i></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">CID</font></p></td>
<td width="460"><in put type="text" name="In3" size="20" value="<?
echo $In3 ?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0"> Your Name*</font></td>
<td width="460">
<input type="text" name="In4" size="40" value="<? echo $In4
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0"> Deptartment*</font></td>
<td width="460">
<input type="text" name="In5" size="40" value="<? echo $In5
?>"></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Phone Number *</font></td>
<td width="460">
<input type="text" name="In12" size="20" maxlength="12" value="<?
echo $In12 ?>">
<font size="0"> (i.e. 000-000-0000) Extension</font>
<input type="text" name="In13" size="8" maxlength="6"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Fax Number</font></td>
<td width="460"> <font size="0">
<input type="text" name="In14" size="20" maxlength="12" value="<?
echo $In14 ?>">
(i.e. 000-000-0000)</font></td>
</tr>
</table><br><p>
<table width="650" border="0" cellspacing="1" cellpadding="4"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Shi pping
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Shippi ng Address*</font></p></td>
<td width="460">
<p>
<input type="text" name="In6" size="80" value="<? echo $In6
?>">
</p></td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">City *</font></td>
<td width="460">
<input type="text" name="In7" size="40" value="<? echo $In7
?>"></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">State* </font></td>
<td width="460">
<select name="state1">
<option selected value="<? echo $state1 ?>"><? echo $state1
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Zip Code*</font></td>
<td width="460">
<input type="text" name="In8" size="12" maxlength="10" value="<?
echo $In8 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt size="0"><b>Bil ling
Information:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Billin g Address*</font></td>
<td width="460">
<input type="text" name="In9" size="80" value="<? echo $In9 ?>">
</td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">City*</font></td>
<td width="460">
<input type="text" name="In10" size="40" value="<? echo $In10
?>"> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">State* </font></td>
<td width="460">
<select name="state2">
<option selected value="<? echo $state2 ?>"><? echo $state2
?></option>
<option value="AL">Alab ama</option>
<option value="AK">Alas ka</option>
<option value="AB">Albe rta</option>
<option value="AZ">Ariz ona</option>
<option value="AR">Arka nsas</option>
<option value="BC">Brit ish Columbia</option>
<option value="CA">Cali fornia</option>
<option value="CO">Colo rado</option>
<option value="CT">Conn ecticut</option>
<option value="DE">Dela ware</option>
<option value="DC">Dist rict of Columbia</option>
<option value="FL">Flor ida</option>
<option value="GA">Geor gia</option>
<option value="HI">Hawa ii</option>
<option value="ID">Idah o</option>
<option value="IL">Illi nois</option>
<option value="IN">Indi ana</option>
<option value="IA">Iowa </option>
<option value="KS">Kans as</option>
<option value="KY">Kent ucky</option>
<option value="LA">Loui siana</option>
<option value="ME">Main e</option>
<option value="MB">Mani toba</option>
<option value="MD">Mary land</option>
<option value="MA">Mass achusetts</option>
<option value="MI">Mich igan</option>
<option value="MN">Minn esota</option>
<option value="MS">Miss issippi</option>
<option value="MO">Miss ouri</option>
<option value="MT">Mont ana</option>
<option value="NE">Nebr aska</option>
<option value="NV">Neva da</option>
<option value="NB">New Brunswick</option>
<option value="NF">Newf oundland</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">Nort h Carolina</option>
<option value="ND">Nort h Dakota</option>
<option value="NS">Nova Scotia</option>
<option value="OH">Ohio </option>
<option value="OK">Okla homa</option>
<option value="ON">Onta rio</option>
<option value="OR">Oreg on</option>
<option value="PA">Penn sylvania</option>
<option value="PE">Prin ce Edward Island</option>
<option value="PQ">Queb ec</option>
<option value="RI">Rhod e Island</option>
<option value="SK">Sask atchewan</option>
<option value="SC">Sout h Carolina</option>
<option value="SD">Sout h Dakota</option>
<option value="TN">Tenn essee</option>
<option value="TX">Texa s</option>
<option value="UT">Utah </option>
<option value="VT">Verm ont</option>
<option value="VA">Virg inia</option>
<option value="WA">Wash ington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisc onsin</option>
<option value="WY">Wyom ing</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Zip Code*</font></td>
<td width="460">
<input type="text" name="In11" size="12" maxlength="10" value="<?
echo $In11 ?>"></td>
</tr>
</table><br><p>
<table width="650" border="0" cellpadding="4" cellspacing="1"
bgcolor="#00000 0">
<tr bgcolor="<? echo $color3 ?>">
<td colspan="2"><fo nt
size="0"><b>Pre view/Purchase:</b></font></td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Video</font></td>
<td width="460">
<select size="1" name="In15">
<option selected>(None) </option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color1 ?>">
<td width="190"><fo nt size="0">Second Video</font></td>
<td width="460"> <select size="1" name="In16">
<option selected>(None) </option>
<option>Age Specific Care</option>
<option>Growt h & Development</option>
<option>Cultu re & Religion</option>
<option>Survivi ng Change</option>
<option>Your Baby</option>
<option>Circumc ision</option>
</select> </td>
</tr>
<tr bgcolor="<? echo $color2 ?>">
<td width="190"><fo nt size="0">Purcha se Order Number</font></td>
<td width="460">
<input type="text" name="In17" size="40"> </td>
</tr>
<tr valign="middle" bgcolor="<? echo $color1 ?>">
<td align="center" colspan="2"><p style="line-height: 100%;
word-spacing: 0; margin-top: 0; margin-bottom: 0">
<input type="submit" value="Submit" name="submit">
<input type="reset" value="Reset" name="reset">
</td>
</tr>
</table>
</form>
</td>
</tr>
<tr>
<td height="17" align="right" valign="middle" ><img
src="images/BaseLine.jpg" width="329" height="27"></td>
</tr>
<tr>
<td height="100%" valign="bottom" align="center">
<?
include("bottom links.php");
?>
</td>
</tr>
</table>
<?
}
?>
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