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 (http://pilotdesigns.com/) 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">