CODEWITHSUNDEEP
phphtml
Anthony Serio
Anthony Serio

Reputation: 11

PHP form to email

I have created a form on our website for an online submission of claims for our work. I have two pages associated with the form. I have a back end .php page with a thank you for submission and the code to POST an e-mail to our business address. When the form is filled out, and then submitted, we are not recieving an e-mail. I am pretty new to coding and this is my first attempt at creating a form. I thought I had the necessary code and .php to do this. I would really appreciate any input on how to make this form come through in an e-mail. My form page appears as such:

-<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">

<html xmlns="http://www.w3.org/1999/xhtml">
<!-- InstanceBegin template="Templates/main_page.dwt" codeOutsideHTMLIsLocked="false" -->
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<!-- InstanceBeginEditable name="doctitle" -->
<title>Assignment Submission</title>
<!--[if lte IE 9]>
   <style type="text/css" title="ie-style-css">
    /* lte IE 9 style*/
   </style>
  <![endif]-->
<!-- InstanceEndEditable -->
<link href="stylesheets/reset.css" rel="stylesheet" type="text/css" />
<link href="stylesheets/index.css" rel="stylesheet" type="text/css" />
<script type="text/javascript" src="scripts/browser-compatibility.js"></script>
<!-- InstanceBeginEditable name="head" -->
<!-- InstanceEndEditable -->
<script type="text/javascript" src="http://cdn.wibiya.com/Toolbars/dir_1424/Toolbar_1424727/Loader_1424727.js"></script>
</head>
<body>
<noscript>
<a href="http://www.wibiya.com/">Web Toolbar by Wibiya</a>
</noscript>
<div class="main_wrapper cf">
  <div class="header cf">
    <div class="logo_holder cf"></div>
    <div class="nav_holder cf">
      <ul class="hmenubar cf">
        <li><a href="index.html" class="clicked" target="_self">Home</a> </li>
        <li><a href="about.html">About</a> </li>
        <li><a href="services.html">Services</a> </li>
        <li><a href="coverage.html">coverage</a> </li>
        <li><a href="assignment.html">submit an assignment</a> </li>
        <li><a href="solutions.html">Resources</a> </li>
        <li><a href="contact.html">Contact</a> </li>
        <script type="text/javascript" src="scripts/menu_selection.js"></script>
      </ul>
    </div>
  </div>
  <div class="content cf"> <!-- InstanceBeginEditable name="ContentRegion" -->
    <div class="column_1">
      <h2 class="about">Assignment Submission Form</h2>
      <h2 class="service_text"><font color="#FF0000">PLEASE BE AWARE WE ARE EXPERIENCING DIFFICULTIES WITH OUR ONLINE SUBMISSION FORM. PLEASE CONTACT US TO PROVIDE US WITH AN ASSIGNMENT AT THIS TIME. (xxx) xxx-xxxx. Thank you.</font><br />

      Please complete as many fields as possible and click submit at the bottom of the page. We will contact you with a confirmation. If you do not hear from us within 2 hours of submission, please contact us. </h2>
      <form id="new_assignment" name="Assignment Form" method="post" action="result.php" class="assign_form">
        <hr />
        <h1 class="revtitle" style="color: rgb(157, 72, 61); text-align: left;">Client Information</h1>
        <hr />
        <p class="paragraph2">
          <label>Company Name:</label>
          <input name="company" type="text" required="required" form="new_assignment" tabindex="1" style="width:225px" />
          <br/>
          <label>Adjuster:</label>
          <input name="adj" type="text" required="required" form="new_assignment" tabindex="2" style="width:200px" />
          <label>E-mail:</label>
          <input name="email" type="email" required="required" form="new_assignment" tabindex="3" style="width:250px" />
          <br/>
          <label>Phone Number:</label>
          <input name="adj_phone_number" type="tel" required="required" form="new_assignment" tabindex="4" style="width:100px" />
          <label>Extension:</label>
          <input name="ext" type="text" form="new_assignment" tabindex="5" style="width:40px" />
          <label>Fax Number:</label>
          <input name="fax" type="tel" form="new_assignment" tabindex="6" style="width:100px" />
        </p>
        <hr />
        <div class="claim_info">
          <h1 class="revtitle" style="color: rgb(157, 72, 61); text-align: left;">Claim Information</h1>
          <hr />
          <p class="paragraph2">
            <label>Assignment Type:</label>
            <select name="assign_type" form="new_assignment" tabindex="7" title="Assignment Type">
              <option value="auto" selected="selected">Automobile</option>
              <option value="rec">Recreational</option>
              <option value="heavy">Heavy Equipment</option>
              <option value="property">Minor Property</option>
              <option value="audit">Estimate Audit</option>
              <option value="scene_invest">Scene Investigation</option>
              <option value="arb">Arbitration</option>
              <option value="DRP">DRP Quality Control Inspection</option>
              <option value="photos">Photos Only</option>
            </select>
            <label>Type of Loss:</label>
            <select name="loss_type" form="new_assignment" tabindex="8" title="Loss Type">
              <option value="coll">Collision</option>
              <option value="comp">Comprehensive</option>
              <option value="other">Other</option>
            </select>
            <br/>
            <label>Claim #:</label>
            <input name="claim_#" type="text" required="required" form="new_assignment" tabindex="9" style="width:225px" />
            <label>Policy #:</label>
            <input name="policy_#" type="text" form="new_assignment" tabindex="10" style="width:150px" />
            <br/>
            <label>Deductible: </label>
            <input name="deductible" type="text" form="new_assignment" tabindex="11" style="width:100px" />
            <label>Date of Loss: </label>
            <input name="dol" type="date" form="new_assignment" tabindex="12" style="width:150px" />
            <br />
          </p>
          <div class="insd_info">
            <label>Insured:</label>
            <input name="insured" type="text" required="required" form="new_assignment" tabindex="13" style="width:200px" />
            <br/>
            <label>Address:</label>
            <input name="insd_address" type="text" form="new_assignment" tabindex="14" style="width:275px" />
            <br/>
            <label>City:</label>
            <input name="insd_city" type="text" form="new_assignment" tabindex="15" style="width:120px" />
            <label>State:</label>
            <select name="insd_state" form="new_assignment" tabindex="16" title="Insured State">
              <option value="AL">AL</option>
              <option value="AK">AK</option>
              <option value="AZ">AZ</option>
              <option value="AR">AR</option>
              <option value="CA">CA</option>
              <option value="CO">CO</option>
              <option value="CT">CT</option>
              <option value="DE">DE</option>
              <option value="FL">FL</option>
              <option value="GA">GA</option>
              <option value="HI">HI</option>
              <option value="ID">ID</option>
              <option value="IL">IL</option>
              <option value="IN">IN</option>
              <option value="IA">IA</option>
              <option value="KS">KS</option>
              <option value="KY">KY</option>
              <option value="LA">LA</option>
              <option value="ME">ME</option>
              <option value="MD">MD</option>
              <option value="MA">MA</option>
              <option value="MI" selected="selected">MI</option>
              <option value="MN">MN</option>
              <option value="MS">MS</option>
              <option value="MO">MO</option>
              <option value="MT">MT</option>
              <option value="NE">NE</option>
              <option value="NV">NV</option>
              <option value="NH">NH</option>
              <option value="NJ">NJ</option>
              <option value="NM">NM</option>
              <option value="NY">NY</option>
              <option value="NC">NC</option>
              <option value="ND">ND</option>
              <option value="OH">OH</option>
              <option value="OK">OK</option>
              <option value="OR">OR</option>
              <option value="PA">PA</option>
              <option value="RI">RI</option>
              <option value="SC">SC</option>
              <option value="SD">SD</option>
              <option value="TN">TN</option>
              <option value="TX">TX</option>
              <option value="UT">UT</option>
              <option value="VT">VT</option>
              <option value="VA">VA</option>
              <option value="WA">WA</option>
              <option value="WV">WV</option>
              <option value="WI">WI</option>
              <option value="WY">WY</option>
            </select>
            <br/>
            <label>Zip Code:</label>
            <input name="insd_ZIP" type="text" form="new_assignment" tabindex="17" style="width:130px" />
            <br/>
            <label>Home Phone:</label>
            <input name="insd_home" type="tel" form="new_assignment" tabindex="18" style="width:140px" />
            <br/>
            <label>Work Phone:</label>
            <input name="insd_work" type="tel" form="new_assignment" tabindex="19" style="width:140px" />
            <br/>
            <label>Mobile Phone:</label>
            <input name="insd_mobile" type="tel" form="new_assignment" tabindex="20" style="width:140px" />
            <br/>
            <label>Other Phone:</label>
            <input name="insd_other" type="tel" form="new_assignment" tabindex="21" style="width:140px " />
            <br/>
          </div>
          <div class="claimant_info ">
            <label>Claimant:</label>
            <input name="claimant " type="text " required="required " form="new_assignment " tabindex="22" style="width:200px " />
            <br/>
            <label>Address:</label>
            <input name="claimant_address " type="text " form="new_assignment " tabindex="23" style="width:275px " />
            <br/>
            <label>City:</label>
            <input name="claimant_city " type="text " form="new_assignment " tabindex="24" style="width:120px " />
            <label>State:</label>
            <select name="claimant_state " form="new_assignment " tabindex="25" title="Claimant State ">
              <option value="AL ">AL</option>
              <option value="AK ">AK</option>
              <option value="AZ ">AZ</option>
              <option value="AR ">AR</option>
              <option value="CA ">CA</option>
              <option value="CO ">CO</option>
              <option value="CT ">CT</option>
              <option value="DE ">DE</option>
              <option value="FL ">FL</option>
              <option value="GA ">GA</option>
              <option value="HI ">HI</option>
              <option value="ID ">ID</option>
              <option value="IL ">IL</option>
              <option value="IN ">IN</option>
              <option value="IA ">IA</option>
              <option value="KS ">KS</option>
              <option value="KY ">KY</option>
              <option value="LA ">LA</option>
              <option value="ME ">ME</option>
              <option value="MD ">MD</option>
              <option value="MA ">MA</option>
              <option value="MI " selected="selected">MI</option>
              <option value="MN ">MN</option>
              <option value="MS ">MS</option>
              <option value="MO ">MO</option>
              <option value="MT ">MT</option>
              <option value="NE ">NE</option>
              <option value="NV ">NV</option>
              <option value="NH ">NH</option>
              <option value="NJ ">NJ</option>
              <option value="NM ">NM</option>
              <option value="NY ">NY</option>
              <option value="NC ">NC</option>
              <option value="ND ">ND</option>
              <option value="OH ">OH</option>
              <option value="OK ">OK</option>
              <option value="OR ">OR</option>
              <option value="PA ">PA</option>
              <option value="RI ">RI</option>
              <option value="SC ">SC</option>
              <option value="SD ">SD</option>
              <option value="TN ">TN</option>
              <option value="TX ">TX</option>
              <option value="UT ">UT</option>
              <option value="VT ">VT</option>
              <option value="VA ">VA</option>
              <option value="WA ">WA</option>
              <option value="WV ">WV</option>
              <option value="WI ">WI</option>
              <option value="WY ">WY</option>
            </select>
            <br/>
            <label>Zip Code:</label>
            <input name="claimant_ZIP " type="text " form="new_assignment " tabindex="26" style="width:130px " />
            <br/>
            <label>Home Phone:</label>
            <input name="claimant_home " type="tel " form="new_assignment " tabindex="27" style="width:140px " />
            <br/>
            <label>Work Phone:</label>
            <input name="claimant_work " type="tel " form="new_assignment " tabindex="28" style="width:140px " />
            <br/>
            <label>Mobile Phone:</label>
            <input name="claimant_mobile " type="tel " form="new_assignment " tabindex="29" style="width:140px " />
            <br/>
            <label>Other Phone:</label>
            <input name="claimant_other" type="tel" form="new_assignment" tabindex="30" style="width:140px" />
          </div>
        </div>
        <br/>
        <br/>
        <br/>
        <br/>
        <br/>
        <br/>
        <br/>
        <br/>
        <br/>
        <br />
        <hr />
        <h1 class="revtitle" style="color: rgb(157, 72, 61); text-align: left;">Vehicle Information</h1>
        <hr />
        <p class="paragraph2">
          <label>Owner of vehicle to be inspected: </label>
          <select name="owner_type" form="new_assingments" tabindex="31" style="width:160px">
            <option value="insd" selected="selected">Insured</option>
            <option value="clmt">Claimant</option>
          </select>
          <br />
          <label>Year: </label>
          <input name="veh_year" type="text" for="new_assignment" tabindex="32" style="width:80px" />
          <label>Make: </label>
          <input name="veh_make" type="text" form="new_assignment" tabindex="33" style="width:100px" />
          <label>Model: </label>
          <input name="veh_model" type="text" form "new_assigment" tabindex="34" style="width:100px" />
          <label>Color: </label>
          <input name="veh_color" type="text" form="new_assignment" tabindex="35" style="width:100px" />
          <br/>
          <label>VIN: </label>
          <input name="veh_VIN" type="text" form="new_assignment" tabindex="36" style="width:200px" />
          <label>License Plate: </label>
          <input name="lic_plate" type="text" form="new_assignment" tabindex="37" style="width:100px" />
          <label>State:</label>
          <select name="license_state " form="new_assignment " tabindex="38" title="License State ">
            <option value="AL ">AL</option>
            <option value="AK ">AK</option>
            <option value="AZ ">AZ</option>
            <option value="AR ">AR</option>
            <option value="CA ">CA</option>
            <option value="CO ">CO</option>
            <option value="CT ">CT</option>
            <option value="DE ">DE</option>
            <option value="FL ">FL</option>
            <option value="GA ">GA</option>
            <option value="HI ">HI</option>
            <option value="ID ">ID</option>
            <option value="IL ">IL</option>
            <option value="IN ">IN</option>
            <option value="IA ">IA</option>
            <option value="KS ">KS</option>
            <option value="KY ">KY</option>
            <option value="LA ">LA</option>
            <option value="ME ">ME</option>
            <option value="MD ">MD</option>
            <option value="MA ">MA</option>
            <option value="MI ">MI</option>
            <option value="MN ">MN</option>
            <option value="MS ">MS</option>
            <option value="MO ">MO</option>
            <option value="MT ">MT</option>
            <option value="NE ">NE</option>
            <option value="NV ">NV</option>
            <option value="NH ">NH</option>
            <option value="NJ ">NJ</option>
            <option value="NM ">NM</option>
            <option value="NY ">NY</option>
            <option value="NC ">NC</option>
            <option value="ND ">ND</option>
            <option value="OH ">OH</option>
            <option value="OK ">OK</option>
            <option value="OR ">OR</option>
            <option value="PA ">PA</option>
            <option value="RI ">RI</option>
            <option value="SC ">SC</option>
            <option value="SD ">SD</option>
            <option value="TN ">TN</option>
            <option value="TX ">TX</option>
            <option value="UT ">UT</option>
            <option value="VT ">VT</option>
            <option value="VA ">VA</option>
            <option value="WA ">WA</option>
            <option value="WV ">WV</option>
            <option value="WI ">WI</option>
            <option value="WY ">WY</option>
          </select>
          <br/>
          <label>Description of Loss: </label>
          <textarea name="desc_of_loss" id="desc_of_loss" form="new_assignment" tabindex="39" style="width:500px"></textarea>
          <br />
          <label>Description of Damage: </label>
          <textarea name="desc_of_dmg" id="desc_of_dmg" form="new_assignment" tabindex="40" style="width:500px"></textarea>
          <br />
        </p>
        <hr />
        <h1 class="revtitle" style="color: rgb(157, 72, 61); text-align: left;">Vehicle Location</h1>
        <hr />
        <p class="paragraph2">
          <label>Location Name: </label>
          <input name="location_name" type="text" form="new_assignment" style="width:250px" tabindex="41" value="With Owner" />
          <br />
          <label>Address: </label>
          <input name="location_address" type="text" form="new_assignment" style="width:300px" tabindex="42" value="(same as owner above)" />
          <br />
          <label>City:</label>
          <input name="insd_city" type="text" form="new_assignment" tabindex="43" style="width:120px" />
          <label>State:</label>
          <select name="insd_state" form="new_assignment" tabindex="44" title="Insured State">
            <option value="AL">AL</option>
            <option value="AK">AK</option>
            <option value="AZ">AZ</option>
            <option value="AR">AR</option>
            <option value="CA">CA</option>
            <option value="CO">CO</option>
            <option value="CT">CT</option>
            <option value="DE">DE</option>
            <option value="FL">FL</option>
            <option value="GA">GA</option>
            <option value="HI">HI</option>
            <option value="ID">ID</option>
            <option value="IL">IL</option>
            <option value="IN">IN</option>
            <option value="IA">IA</option>
            <option value="KS">KS</option>
            <option value="KY">KY</option>
            <option value="LA">LA</option>
            <option value="ME">ME</option>
            <option value="MD">MD</option>
            <option value="MA">MA</option>
            <option value="MI" selected="selected">MI</option>
            <option value="MN">MN</option>
            <option value="MS">MS</option>
            <option value="MO">MO</option>
            <option value="MT">MT</option>
            <option value="NE">NE</option>
            <option value="NV">NV</option>
            <option value="NH">NH</option>
            <option value="NJ">NJ</option>
            <option value="NM">NM</option>
            <option value="NY">NY</option>
            <option value="NC">NC</option>
            <option value="ND">ND</option>
            <option value="OH">OH</option>
            <option value="OK">OK</option>
            <option value="OR">OR</option>
            <option value="PA">PA</option>
            <option value="RI">RI</option>
            <option value="SC">SC</option>
            <option value="SD">SD</option>
            <option value="TN">TN</option>
            <option value="TX">TX</option>
            <option value="UT">UT</option>
            <option value="VT">VT</option>
            <option value="VA">VA</option>
            <option value="WA">WA</option>
            <option value="WV">WV</option>
            <option value="WI">WI</option>
            <option value="WY">WY</option>
          </select>
          <br/>
          <label>Zip Code: </label>
          <input name="insd_ZIP" type="text" form="new_assignment" tabindex="45" style="width:130px" />
          <label>Contact: </label>
          <input name="location_contact" type="text" form="new_assignment" tabindex="46" style="width:150px"  />
          <br/>
        </p>
        <hr />
        <input type="reset" class="button" />
        <input name="submit" type="submit" class="button" form="new_assignment" formaction="/result.php" formenctype="multipart/form-data" formmethod="POST" value="Submit" />
        <p></p>
        <div class="important" id="important">
          <label>Trojan</label>
          <input type="text" name="trojan" id="trojan" />
        </div>
      </form>
    </div>
  <!-- InstanceEndEditable --> </div>
  <div class="footer cf">
    <p class="rights">LMC Insurance Services, INC &nbsp;- &nbsp;2013 All Rights Reserved | <a class="privacy" href="/privacy_policy.html" target="_self">Privacy Policy</a> </p>
  </div>
</div>
</body>
<!-- InstanceEnd -->
</html>

And my .php results page appears as:

<!doctype html>
<html>
<head>
<meta charset="UTF-8">
<title>Submission</title>
</head>

<body>
<?PHP

//checks if bot

if($_POST['trojan']!='');
die("Changed field");

$adj = $_POST['adj'];
$company = $_POST['company'];
$email = $_POST['email'];
$adj_phone = $_POST['adj_phone_number'];
$ext = $_POST['ext'];

//Sending Email to form owner
$header = "From: $email\n"
. "Relpy-To: $email\n";
$subject = "New Assignment from Website";
$email_to = "office@example.com";
$message = "We recieved a new assignment from $adj \n"
. "They can be reached at $adj_phone $ext \n"
. "Their e-mail address is $email \n";

mail($email_to,$subject,$message,$header);

?>

<h1>Thank you for your submission!</h1>
<p>Your information has been sent, and our office will contact you to verify the assignment and confirm any special instructions.</p>
<p>We thank you for utilizing our services. We hope to complete your assignment in a timely manner.</p> 
</body>
</html>

Any and all help is greatly appreciated.

Upvotes: 1

Views: 222

Answers (4)

Ishikawa91
Ishikawa91

Reputation: 404

At your if statement:

if($_POST['trojan'] != '');
die("Changed field");

Should be:

if($_POST['trojan'] != ''){
   die("Changed field");
}

Upvotes: 0

Ryan
Ryan

Reputation: 28247

A few things to check:

  • Is your mail server properly configured?
  • Can you send test email successfully?
  • Do you have any other control in place to test whether the infrastructure overall works, rather than just the one script that is not currently working?

Also consider using a library such as PHPMailer (http://phpmailer.worxware.com/). It offers much more flexibility when it comes to configuring your mail server.

Upvotes: 0

fred2
fred2

Reputation: 1110

I haven't checked the code in detail, but the most likely problem is that the server is not set up to send mail.

Check

a) php settings for mail (you can do this by running phpinfo(); but usually these are set up correctly out of the box.

b) Check server mail application is installed and configured, eg Exim, Sendmail, etc.

Setting up a server to send (but not receive) mail is fairly easy. Eg on a Debian server you would run something like

 sudo apt-get install exim4

And then follow instructions to configure it to send mail.

Upvotes: 0

Fallen
Fallen

Reputation: 4565

remove the ; from

if($_POST['trojan']!='');
                        ^
                        here

because I think this following statement is executed every time as that semicolon make the following line independent of that if statement

 die("Changed field");

Upvotes: 2

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