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Contact script doesn't work on certain servers

hoefie

By hoefie
in PHP Coding Help

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hoefie Newbie

hoefie

Posted
Posted

Hey everyone. I'm new here. I really need some help. I have a contact script wich works fine on certain servers, but on others it doesn't work. People told me that I should change the code so that it could work on that specific server. They told me that this code must be changed to php5. I don't know exactly where to change it. So please help

 

here's the code

 

<?php

$recipientname = "Chat and Date World";

$recipientemail = "[email protected]";

$subject = "[Contact via website Chat and Date World] ";

$autoresponse = "yes";

 

$autosubject = "Thanks for your application!";

$automessage = "This message is sent automatically. We have received your application at Chat and Date World succesfully.

 

 

Thanks. We'll respond asap.

 

- Chat and Date World.";

 

$thanks = "<font size=3 color='#307C1F'><b>Succes!</b></font><br>Your application is sent succesfully.

 

<p>";

?>

            </p>

            <p> </p>

            <p>

             

              <?php

if($_POST['submitform']) {

 

$Naam = $HTTP_POST_VARS['Naam'];

$Email = $HTTP_POST_VARS['Email'];

$Bericht = $HTTP_POST_VARS['Bericht'];

$Onderwerp = $HTTP_POST_VARS['Onderwerp'];

$Plaats = $HTTP_POST_VARS['Plaats'];

$Typedienst = $HTTP_POST_VARS['Typedienst'];

 

$dcheck = explode(",",$require);

while(list($check) = each($dcheck)) {

if(!$$dcheck[$check]) {

$error .= "<font color=red>$dcheck[$check] ontbreekt.</font><br>";

}

}

 

if ((!ereg(".+\@.+\..+", $Email)) || (!ereg("^[[email protected]]+$", $Email))){

$error .= "<font color=red>The e-mail adres is incorrect.</font><br>";}

 

if($error) {

?>

             

              <b><img src="../main needs/error.jpg" alt="Error"><br>

              <?php echo $error; ?><br>

              <a href="#" onClick="history.go(-1)">Ga terug</a>

             

             

                <?php

}

else

{

 

$browser = $HTTP_USER_AGENT;

$ip = $REMOTE_ADDR;

 

 

$message = "

===============================================

Dit bericht is verzonden via www.chatanddateworld.com

===============================================

 

Naam: $Naam

Bedrijf: $Bedrijfsnaam

Plaats: $Plaats

 

Land: $Land

Adres: $Adres

Telefoon nummer: $Telefoon

Mobiel nummer: $Mobiel

Postcode: $Postcode

 

Email: $Email

Onderwerp: $Onderwerp

Type dienst: $Typedienst

 

Korte beschrijving van de dienst:

$Bericht

 

Hoe vaak wilt u gebruik maken van deze dienst?: $hoevaak

 

 

----------------------------------------------------

 

Browser: $browser

User IP: $ip";

 

mail($recipientemail,"$subject","$message","From: $Naam <$Email>");

 

if($autoresponse == "yes") {

$autosubject = stripslashes($autosubject);

$automessage = stripslashes($automessage);

mail($Email,"$autosubject","$automessage","From: $recipientname <$recipientemail>");

}

 

echo "$thanks";

}

}

else {

?>

             

              </p>

          </div>

          <form name="contactform" action="<?php $_POST['PHP_SELF']; ?>" method="post">

<input type="hidden" name="require" value="Naam,Email,Bericht,Onderwerp,Land,Typedienst">

<table align="center">

  <tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Naam * :</font></span></td>

<td valign="top" align="left"><input name="Naam" size="32"></td>

</tr><tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Bedrijfsnaam:</font></span></td>

<td valign="top" align="left"><input name="Bedrijfsnaam" size="32"></td>

</tr>

    <td valign="top" align="left"><span class="style5"><font face="tahoma">E-mail * :</font></span></td>

      <td valign="top" align="left"><input name="Email" size="32"></td>

</tr><tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Onderwerp * :</font></span></td>

<td valign="top" align="left"><input name="Onderwerp" size="32"><p></td>

</tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Land * :</font></span></td>

<td valign="top" align="left"><SELECT NAME="Land">

 

<option value="USA">USA</option>

<option value="UK">UK</option>

<option value="Albania">Albania</option>

<option value="Algeria">Algeria</option>

<option value="American Samoa">American Samoa</option>

<option value="Andorra">Andorra</option>

<option value="Angola">Angola</option>

<option value="Anguilla">Anguilla</option>

<option value="Antigua">Antigua</option>

<option value="Argentina">Argentina</option>

<option value="Armenia">Armenia</option>

<option value="Aruba">Aruba</option>

<option value="Australia">Australia</option>

<option value="Austria">Austria</option>

<option value="Azerbaijan">Azerbaijan</option>

<option value="Bahamas">Bahamas</option>

<option value="Bahrain">Bahrain</option>

<option value="Bangladesh">Bangladesh</option>

<option value="Barbados">Barbados</option>

<option value="Barbuda">Barbuda</option>

<option value="Belgium">Belgium</option>

<option value="Belize">Belize</option>

<option value="Benin">Benin</option>

<option value="Bermuda">Bermuda</option>

<option value="Bhutan">Bhutan</option>

<option value="Bolivia">Bolivia</option>

<option value="Bonaire">Bonaire</option>

<option value="Botswana">Botswana</option>

<option value="Brazil">Brazil</option>

<option value="Virgin islands">British Virgin isl.</option>

<option value="Brunei">Brunei</option>

<option value="Bulgaria">Bulgaria</option>

<option value="Burundi">Burundi</option>

<option value="Cambodia">Cambodia</option>

<option value="Cameroon">Cameroon</option>

<option value="Canada">Canada</option>

<option value="Cape Verde">Cape Verde</option>

<option value="Cayman isl">Cayman Islands</option>

<option value="Central African Rep">Central African Rep.</option>

<option value="Chad">Chad</option>

<option value="Channel isl">Channel Islands</option>

<option value="Chile">Chile</option>

<option value="China">China</option>

<option value="Colombia">Colombia</option>

<option value="Congo">Congo</option>

<option value="cook isl">Cook Islands</option>

<option value="Costa Rica">Costa Rica</option>

<option value="Croatia">Croatia</option>

<option value="Curacao">Curacao</option>

<option value="Cyprus">Cyprus</option>

<option value="Czech Republic">Czech Republic</option>

<option value="Denmark">Denmark</option>

<option value="Djibouti">Djibouti</option>

<option value="Dominica">Dominica</option>

<option value="Dominican Republic">Dominican Republic</option>

<option value="Ecuador">Ecuador</option>

<option value="Egypt">Egypt</option>

<option value="El Salvador">El Salvador</option>

<option value="Equatorial Guinea">Equatorial Guinea</option>

<option value="Eritrea">Eritrea</option>

<option value="Estonia">Estonia</option>

<option value="Ethiopia">Ethiopia</option>

<option value="Faeroe isl">Faeroe Islands</option>

<option value="Fiji">Fiji</option>

<option value="Finland">Finland</option>

<option value="France">France</option>

<option value="French Guiana">French Guiana</option>

<option value="French Polynesia">French Polynesia</option>

<option value="Gabon">Gabon</option>

<option value="Gambia">Gambia</option>

<option value="Georgia">Georgia</option>

<option value="Gemany">Germany</option>

<option value="Ghana">Ghana</option>

<option value="Gibraltar">Gibraltar</option>

<option value="GB">Great Britain</option>

<option value="Greece">Greece</option>

<option value="Greenland">Greenland</option>

<option value="Grenada">Grenada</option>

<option value="Guadeloupe">Guadeloupe</option>

<option value="Guam">Guam</option>

<option value="Guatemala">Guatemala</option>

<option value="Guinea">Guinea</option>

<option value="Guinea Bissau">Guinea Bissau</option>

<option value="Guyana">Guyana</option>

<option value="Haiti">Haiti</option>

<option value="Honduras">Honduras</option>

<option value="Hong Kong">Hong Kong</option>

<option value="Hungary">Hungary</option>

<option value="Iceland">Iceland</option>

<option value="India">India</option>

<option value="Indonesia">Indonesia</option>

<option value="Irak">Irak</option>

<option value="Iran">Iran</option>

<option value="Ireland">Ireland</option>

<option value="Northern Ireland">Ireland, Northern</option>

<option value="Israel">Israel</option>

<option value="Italy">Italy</option>

<option value="Ivory Coast">Ivory Coast</option>

<option value="Jamaica">Jamaica</option>

<option value="Japan">Japan</option>

<option value="Jordan">Jordan</option>

<option value="Kazakhstan">Kazakhstan</option>

<option value="Kenya">Kenya</option>

<option value="Kuwait">Kuwait</option>

<option value="Kyrgyzstan">Kyrgyzstan</option>

<option value="Latvia">Latvia</option>

<option value="Lebanon">Lebanon</option>

<option value="Liberia">Liberia</option>

<option value="Liechtenstein">Liechtenstein</option>

<option value="Lithuania">Lithuania</option>

<option value="Luxembourg">Luxembourg</option>

<option value="Macau">Macau</option>

<option value="Macedonia">Macedonia</option>

<option value="Madagascar">Madagascar</option>

<option value="Malawi">Malawi</option>

<option value="Malaysia">Malaysia</option>

<option value="Maldives">Maldives</option>

<option value="Mali">Mali</option>

<option value="Malta">Malta</option>

<option value="Marshall isl">Marshall Islands</option>

<option value="Martinique">Martinique</option>

<option value="Mauritania">Mauritania</option>

<option value="Mauritius">Mauritius</option>

<option value="Mexico">Mexico</option>

<option value="Micronesia">Micronesia</option>

<option value="Moldova">Moldova</option>

<option value="Monaco">Monaco</option>

<option value="Mongolia">Mongolia</option>

<option value="Montserrat">Montserrat</option>

<option value="Morocco">Morocco</option>

<option value="Mozambique">Mozambique</option>

<option value="Myanmar">Myanmar/Burma</option>

<option value="Namibia">Namibia</option>

<option value="Nepal">Nepal</option>

<option value="Netherlands">Netherlands</option>

<option value="Netherlands Antilles">Netherlands Antilles</option>

<option value="New Caledonia">New Caledonia</option>

<option value="New Zealand">New Zealand</option>

<option value="Nicaragua">Nicaragua</option>

<option value="Niger">Niger</option>

<option value="Nigeria">Nigeria</option>

<option value="Norway">Norway</option>

<option value="Oman">Oman</option>

<option value="Palau">Palau</option>

<option value="Panama">Panama</option>

<option value="Papua New Guinea">Papua New Guinea</option>

<option value="Paraguay">Paraguay</option>

<option value="Peru">Peru</option>

<option value="Philippines">Philippines</option>

<option value="Poland">Poland</option>

<option value="Portugal">Portugal</option>

<option value="Puerto Rico">Puerto Rico</option>

<option value="Qatar">Qatar</option>

<option value="Reunion">Reunion</option>

<option value="Rwanda">Rwanda</option>

<option value="Saba">Saba</option>

<option value="Saipan">Saipan</option>

<option value="Saudi Arabia">Saudi Arabia</option>

<option value="Scotland">Scotland</option>

<option value="Senegal">Senegal</option>

<option value="Seychelles">Seychelles</option>

<option value="Sierra Leone">Sierra Leone</option>

<option value="Singapore">Singapore</option>

<option value="Slovac Republic">Slovak Republic</option>

<option value="Slovenia">Slovenia</option>

<option value="South Africa">South Africa</option>

<option value="South Korea">South Korea</option>

<option value="Spain">Spain</option>

<option value="Sri Lanka">Sri Lanka</option>

<option value="Sudan">Sudan</option>

<option value="Suriname" selected="selected">Suriname</option>

<option value="Swaziland">Swaziland</option>

<option value="Sweden">Sweden</option>

<option value="Switzerland">Switzerland</option>

<option value="Syria">Syria</option>

<option value="Taiwan">Taiwan</option>

<option value="Tanzania">Tanzania</option>

<option value="Thailand">Thailand</option>

<option value="Togo">Togo</option>

<option value="Trinidad-Tobago">Trinidad-Tobago</option>

<option value="Tunesia">Tunisia</option>

<option value="Turkey">Turkey</option>

<option value="Turkmenistan">Turkmenistan</option>

<option value="United Arab Emirates">United Arab Emirates</option>

<option value="U.S. Virgin isl">U.S. Virgin Islands</option>

<option value="USA">U.S.A.</option>

<option value="Uganda">Uganda</option>

<option value="United Kingdom">United Kingdom</option>

<option value="Urugay">Uruguay</option>

<option value="Uzbekistan">Uzbekistan</option>

<option value="Vanuatu">Vanuatu</option>

<option value="Vatican City">Vatican City</option>

<option value="Venezuela">Venezuela</option>

<option value="Vietnam">Vietnam</option>

<option value="Wales">Wales</option>

<option value="Yemen">Yemen</option>

<option value="Zaire">Zaire</option>

<option value="Zambia">Zambia</option>

<option value="Zimbabwe">Zimbabwe</option>

 

</SELECT></td>

</tr>

 

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Stad:</font></span></td>

<td valign="top" align="left"><input name="Stad" size="32"></td>

</tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Adres:</font></span></td>

<td valign="top" align="left"><input name="Adres" size="32"></td>

</tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Telefoon:</font></span></td>

<td valign="top" align="left"><input name="Telefoon" size="20"></td>

</tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Mobiel:</font></span></td>

<td valign="top" align="left"><input name="Mobiel" size="20"></td>

</tr>

<tr>

<td valign="top" align="left"><span class="style5"><font face="tahoma">Postcode:</font></span></td>

<td valign="top" align="left"><input name="Postcode" size="20"><p></td>

</tr>

 

<tr> 

<td valign="top" align="left"><span class="style5"><font face="tahoma">commentaar</font></span></td>

<td valign="top" align="left"><textarea name="Bericht" rows="12" cols="33" style="font-family:Arial, Helvetica, sans-serif"></textarea></td>

</tr>

 

<tr>

<td valign="top" align="left"><font color="#FFFFFF" face="tahoma">:</font></td>

<td valign="top" align="left"><input name="Typedienst" size="20"><p></td>

</tr>

 

<tr>

<td colspan="2" align="center"><input type="submit" value="Submit" name="submitform">

<input type="reset" value="Reset" name="reset"></td>

</tr></table>

<p align="center">* = Verplichte velden</p>

</form>

<?php } ?>

PFMaBiSmAd Advanced Member

PFMaBiSmAd

Posted
Posted

The code is using the register_long_arrays variables, which are turned off by default in php5 and are eliminated in php6.

 

I recommend turning on full php error reporting to get php to tell you what variables it finds that are not defined that would need to be changed from their depreciated register_long_arrays version to the current variable name.

 

The code might be doing other things that are a problem, but since the code was not posted using bbcode tags, it is a bit hard to read.

hoefie Newbie

hoefie

Posted
  • Author
Posted

Ow I'm sorry. Here's the code

 

<?php
$recipientname = "Bouwvast Jankie";
$recipientemail = "[email protected]";
$subject = "[bouwvastJankie.sr] ".$Onderwerp;
$autoresponse = "yes";

$autosubject = "Bedankt voor uw bericht!";
$automessage = "
Dit is een automatisch verzonden bericht om u te laten weten dat wij met succes uw bericht via BouwvastJankie.sr hebben ontvangen.

Nog bedankt. Wij komen gauw bij u terug.

-Aannemingsbedrijf Bouwvast Jankie N.V.";

$thanks = "<font size=3 color='#307C1F'><b>Gefeliciteerd!</b></font><br>Uw bericht is verzonden.

<p><a href='index.php'>Terug naar Home</a>";
?>

<table width="100%" height="100%"><tr>
<td valign="top"><font face="Arial,Helvetica" size="2">

<?php
if($_POST['submitform']) {

$Naam = $HTTP_POST_VARS['Naam'];
$Email = $HTTP_POST_VARS['Email'];
$Bericht = $HTTP_POST_VARS['Bericht'];
$Onderwerp = $HTTP_POST_VARS['Onderwerp'];
$Land = $HTTP_POST_VARS['Land'];


$dcheck = explode(",",$require);
while(list($check) = each($dcheck)) {
if(!$$dcheck[$check]) {
$error .= "<font color=red>$dcheck[$check] ontbreekt.</font><br>";
}
}

if ((!ereg(".+\@.+\..+", $Email)) || (!ereg("^[[email protected]]+$", $Email))){
$error .= "<font color=red>Het e-mail adres is onjuist.</font><br>";}

if($error) {
?>

<b><img src="Graphics/error.jpg" alt="Error"><br>
<?php echo $error; ?><br>
<a href="#" onClick="history.go(-1)">Ga terug</a>


<?php
}
else 
{

$browser = $HTTP_USER_AGENT;
$ip = $REMOTE_ADDR;


$message = "
===================================================
Dit bericht is verzonden via www.BouwvastJankie.sr
===================================================

Naam: $Naam
Bedrijf: $Bedrijfsnaam
Land: $Land

Stad: $Stad
Adres: $Adres
Telefoon nummer: $Telefoon
Mobiel nummer: $Mobiel
Postcode: $Postcode

Email: $Email
Onderwerp: $Onderwerp

Bericht:
$Bericht



----------------------------------------------------

Browser: $browser
User IP: $ip";

mail($recipientemail,"$subject","$message","From: $Naam <$Email>");

if($autoresponse == "yes") {
$autosubject = stripslashes($autosubject);
$automessage = stripslashes($automessage);
mail($Email,"$autosubject","$automessage","From: $recipientname <$recipientemail>");
}

echo "$thanks";
}
} 
else {
?>

<form name="contactform" action="<?php echo $PHP_SELF; ?>" method="post">
<input type="hidden" name="require" value="Naam,Email,Bericht,Onderwerp,Land">
<table><tr> 
<td valign="top" align="left"><strong>Naam * :</strong></td>
<td valign="top" align="left"><input name="Naam" size="32"></td>
</tr><tr> 
<tr> 
<td valign="top" align="left"><strong>Bedrijfsnaam:</strong></td>
<td valign="top" align="left"><input name="Bedrijfsnaam" size="32"></td>
</tr>
    <td valign="top" align="left"><strong>E-mail * :</strong></td>
      <td valign="top" align="left"><input name="Email" size="32"></td>
</tr><tr>
<td valign="top" align="left"><strong>Onderwerp * :</strong></td>
<td valign="top" align="left"><input name="Onderwerp" size="32"><p></td>
</tr>
<tr>
<td valign="top" align="left"><strong>Land * :</strong></td>
<td valign="top" align="left"><SELECT NAME="Land">
<option value="USA">USA</option>
<option value="UK">UK</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua">Antigua</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Barbuda">Barbuda</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bonaire">Bonaire</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="Virgin islands">British Virgin isl.</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman isl">Cayman Islands</option>
<option value="Central African Rep">Central African Rep.</option>
<option value="Chad">Chad</option>
<option value="Channel isl">Channel Islands</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Colombia">Colombia</option>
<option value="Congo">Congo</option>
<option value="cook isl">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Curacao">Curacao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Faeroe isl">Faeroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Gemany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="GB">Great Britain</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guinea Bissau">Guinea Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Irak">Irak</option>
<option value="Iran">Iran</option>
<option value="Ireland">Ireland</option>
<option value="Northern Ireland">Ireland, Northern</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Liberia">Liberia</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall isl">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar/Burma</option>
<option value="Namibia">Namibia</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Rwanda">Rwanda</option>
<option value="Saba">Saba</option>
<option value="Saipan">Saipan</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Scotland">Scotland</option>
<option value="Senegal">Senegal</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovac Republic">Slovak Republic</option>
<option value="Slovenia">Slovenia</option>
<option value="South Africa">South Africa</option>
<option value="South Korea">South Korea</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname" selected="selected">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Trinidad-Tobago">Trinidad-Tobago</option>
<option value="Tunesia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="U.S. Virgin isl">U.S. Virgin Islands</option>
<option value="USA">U.S.A.</option>
<option value="Uganda">Uganda</option>
<option value="United Kingdom">United Kingdom</option>
<option value="Urugay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Wales">Wales</option>
<option value="Yemen">Yemen</option>
<option value="Zaire">Zaire</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>

</SELECT>
</td>
</tr>

<tr> 
<td valign="top" align="left"><strong>Stad:</strong></td>
<td valign="top" align="left"><input name="Stad" size="32"></td>
</tr>
<tr> 
<td valign="top" align="left"><strong>Adres:</strong></td>
<td valign="top" align="left"><input name="Adres" size="32"></td>
</tr>
<tr> 
<td valign="top" align="left"><strong>Telefoon:</strong></td>
<td valign="top" align="left"><input name="Telefoon" size="20"></td>
</tr>
<tr> 
<td valign="top" align="left"><strong>Mobiel:</strong></td>
<td valign="top" align="left"><input name="Mobiel" size="20"></td>
</tr>
<tr> 
<td valign="top" align="left"><strong>Postcode:</strong></td>
<td valign="top" align="left"><input name="Postcode" size="20"><p></td>
</tr>

<tr>  
<td valign="top" align="left"><strong>Bericht * :</strong></td>
<td valign="top" align="left"><textarea name="Bericht" rows="12" cols="60" style="font-family:Arial, Helvetica, sans-serif"></textarea></td>
</tr><tr> 
<td colspan="2" align="center"><input type="submit" value="Submit" name="submitform">
<input type="reset" value="Reset" name="reset"></td>
</tr></table>
<p align="center">* = Verplichte velden</p>
</form>
<?php } ?>
</font><p>
</center>


</td>
</tr></table>

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