Form

[cbrams9]

Hi All,

Im just trying to do an Application Form on a site im doing, but need help!

Please could anyone help with the following -

Have the Application Form - submit into mysql database,
does javascript need to be used for the submit button also?

Have the Form - sent to an email address

Have Form - validation

Below is my form -

<br><b>Section 1</b>
                               <br>Details of person/people for whom help is being    sought.<br>
                    </td>
                  </tr>   

              <form action="insert.php" method="post">

 <tr>
             <td>Name:</td>
      <td><input name="name" type="text" size="100">
              <br></td>
       </tr>
 <tr>
             <td>Date of Birth: </td>
             <td><input type="text" name="dob"><br></td>
       </tr>
        <tr>
             <td>Address 1:</td>
             <td><input type="text" name="a1"><br></td>
       </tr>
        <tr>
             <td>Address 2:</td> 
      <td><input type="text" name="a2"><br></td>
       </tr>
        <tr>
             <td>Postcode:</td> 
             <td><input type="text" name="psc"><br></td>
       </tr>
        <tr>
             <td>Town/City:</td> 
             <td><input type="text" name="tc"><br></td>
       </tr>
        <tr>
             <td>Phone: </td>
             <td><input type="text" name="phone"><br></td>
       </tr>
        <tr>
             <td>Email:</td> 
             <td><input type="text" name="email"><br></td>
       </tr>
        <tr>
             <td>Type of request:</td>
             <td><select name='typerequest'>
          <option selected>Please Select
          <option>Equipment for home
          <option>Medical
          <option>Transport
                </select><br></td>
       </tr>
        <tr>
             <td>Amount of grant required:</td>
             <td><select name='grant'>
          <option selected>Please Select
          <option>Up to - £1000
          <option>Up to - £3000
          <option>Up to - £5000
               </select><br></td>
       </tr>
        <tr>
            <td>Brief outline of request:</td>
            <td><textarea name="outlinerequest"></textarea><br></td>
       </tr>
        <tr>
            <td>Details of request:</td> 
            <td><textarea name="detailsrequest"></textarea><br></td>
       </tr>
          </table>
        <tr>     

            <td><br><b>Section 2</b><br>Relationship to person/people above 
                <select name='relate'>
         <option selected>Please Select
         <option>Parent
         <option>Friend
         <option>Therapist
                <option>Representative of institution
                <option>Other
              </select><br></td>
       </tr> 
        <tr>
         <table width="100%" height="270" border="0">
         <tr>
            <td><br>Name:</td>
            <td><input type="text" name="name2"><br></td>
       </tr>
        <tr>
            <td>Address 1:</td>
            <td><input type="text" name="a12"><br></td>
       </tr>
        <tr>
            <td>Address 2:</td>
            <td><input type="text" name="a22"><br></td>
       </tr> 
        <tr>
            <td>Postcode:</td>
            <td><input type="text" name="psc2"><br></td>
       </tr>
        <tr>
            <td>Town/City:</td>
            <td><input type="text" name="tc2"><br></td>
       </tr>
        <tr>
            <td>Phone:</td>
            <td><input type="text" name="phone2"><br></td>
       </tr>
        <tr>
            <td>Email:</td> 
            <td><input type="text" name="email2"><br></td>
       </tr>   
 <tr>
         
        </form>

       <tr>
           <td>Submit</td>
       </tr>
       <tr>
     <td>
If you have any questions regarding this form or it does not meet your needs, please 
feel free to email <a href='mailto:brenda.yong@sfcharity.co.uk'>Brenda Yong</a>

         </td>
       </tr>

Php code so far -

<?php
$user="c";
$password="c";
$database="charity";

mysql_connect("localhost",$user,$password);
if(!mysql_select_db($database) )
echo mysql_error();


$query = "INSERT INTO contacts VALUES

mysql_query($query);
mysql_close();
echo "ok";
?>

Please can anyone help??

Thanks

[gnubler]

This may not be what you're looking for, but thanks to Pilot Designs I found a fantastic PHP script to send form results to an email address. It's so easy even a gnubler can do it.

Here's the URL: http://www.scriptsearch.com/cgi-bin/jump.cgi?ID=1449

Here's the PHP code:

<?php

//--------------------------Set these parameters--------------------------


$subject = 'Form Submission';                // Subject of email sent to you.
$emailadd = 'youremail@anywhere.com';        // Your email address. This is where the form information will be sent.
$url = 'http://www.mydomain.com/whatever/';               // Where to redirect after form is processed.
$req = '1';                                  // Makes all fields required. If set to '1' no field can not be empty. If set to '0' any or all fields can be empty.

// --------------------------Do not edit below this line--------------------------
$text = "Results from form:\n\n";       
$space = '  ';
$line = '
';
foreach ($_POST as $key => $value)
{
	if ($req == '1')
	{
		if ($value == '')
		{echo "$key is empty";die;}
	}
	$j = strlen($key);
		if ($j >= 20)
		{echo "Name of form element $key cannot be longer than 20 characters";die;}
	$j = 20 - $j;
		for ($i = 1; $i <= $j; $i++)
		{$space .= ' ';}
	$value = str_replace('\n', "$line", $value);
	$conc = "{$key}:$space{$value}$line";
	$text .= $conc;
	$space = '  ';
}
mail($emailadd, $subject, $text, 'From: '.$emailadd.'');
echo '<META HTTP-EQUIV=Refresh CONTENT="0; URL='.$url.'">';
?>

And here's the code to put at the beginning of your form in your HTML document:

<form action="nameofformscript.php" method="post" class="cssform">