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benjamin_boothe

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I want all the data I put onto the form to print into my back-end SQL database.

This is the code I have used:

<META content="MSHTML 6.00.2800.1458" name=GENERATOR></HEAD>
<BODY bgColor=#99ccff>
<DIV><B>GSI Insurance LTD</B> (Customer Contact Page)</DIV>
<HR>
<STYLE>.req {
COLOR: #ff0033
}
</STYLE>

<?

if ($_POST) {

  $msg = "";

  foreach($_POST as $k => $v) {
        $v = trim($v);
        $$k = $v;

        if ($v=="") {
          $msg = "Please fill in all fields";
        }
  }

  if ($msg=="") {
      $insert = "INSERT INTO claim_history, insurance_cover_type, licence,
        policy_holder, vehicle
        (title, first_name, surname, first_name, date_of_birth,
        uk_residency, marital_status, disability, employment_status,
        address_line_1, area, town, county, post_code, daytime_tel_no,
        evening_tel_no, email_address, manufacturer, model, reg_no, year_purchased, current_value,
        seats_incl_driver, cubic_capacity, annual_mileage, registered_owner,
        if_not_register_owner_please_supply_name, overnight_vehicle_location,
        licensing_authority, cover_required, class_of_use, type_of_bonus, policy_start_date,
        current_previous_insurer, current_previous_insurance_broker,
        target_premium, who_quoted, claim_1_date, claim_1_fault, claim_1_type,
        claim_1_repair_cost, claim_1_effect_on_NCB, claim_2_date, claim_2_fault,
        claim_2_type, claim_2_repair_cost, claim_2_effect_on_NCB, licence_type,
        years_held, additional_driver_name_1,addition_driver_1_licence_type,
        additional_driver_1_years_held)
        VALUES ('$t', '$fn', '$sn', '$fn', '$dob', '$uk', '$ms', '$d', '$es',
        '$ad1', '$a', '$tn', '$c', '$pc', '$dtn', '$etn', '$ee', '$m', '$mod', '$reg', '$yrp',
        '$cv', '$seats', '$cc', '$am', '$ro', '$notro', '$ovl', '$la', '$cr', '$class', '$tob',
        '$psd', '$cpi', $cpib', '$tp', '$wq', '$cd1', '$cf1', '$ct1', '$crc1',
        '$ncb1', '$cd2', '$cf2', '$ct2', '$crc2', '$ncb2', '$lt', '$yh', '$adn1',
        '$ad1', '$adlt1', '$adyh1')";

        include 'includes/db_conn.txt';

        if (!mysqli_query($link, $insert)) {
          $msg = "Error inserting data";
        } else {
          $msg = "Record succesfully added";

        $t = $fn = $sn = $fn = $dob = $uk = $ms = $d = $es = $ad1 = $a = $tn =
        $c = $pc = $dtn = $etn = $ee = $m = $mod = $reg = $yrp = $cv = $seats = $cc = $am =
        $ro = $notro = $ovl = $la = $cr = $class = $tob = $psd = $cpi = $cpib = $tp = $wq = $cd1
        = $cf1 = $ct1 = $crc1 = $ncb1 = $cd2 = $cf2 = $ct2 = $crc2 = $ncb2 = $lt
        = $yh = $adn1 = $ad1 = $adlt1 = $adyh1 = "";
        }
        mysqli_close($link);
  }

echo "<div class=\"error\">$msg</div>";

} else {
  $t = $fn = $sn = $fn = $dob = $uk = $ms = $d = $es = $ad1 = $a = $tn =
  $c = $pc = $dtn = $etn = $ee = $m = $mod = $reg = $yrp = $cv = $seats = $cc = $am =
  $ro = $notro = $la = $ovl = $cr = $class = $tob = $psd = $cpi = $cpib = $tp = $wq = $cd1
  = $cf1 = $ct1 = $crc1 = $ncb1 = $cd2 = $cf2 = $ct2 = $crc2 = $ncb2 = $lt =
  $yh = $adn1 = $ad1 = $adlt1 = $adyh1 = "";
}
?>




<FORM METHOD="post" ACTION="<? echo $SERVER['localhost'] ?>">
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Personal Details Items in <SPAN class=req>red</SPAN> or
      marked with <SPAN class=req>*</SPAN> are required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Title *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="title" VALUE="<? echo $t ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=Mr>Mr</OPTION> <OPTION value=Mrs>Mrs</OPTION>
    <OPTION value=Miss>Miss</OPTION>
    <OPTION value=MS>MS</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>First Name *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="first_name" VALUE="<? echo $fn ?>"/><BR>
    </TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Last Name *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="surname" VALUE="<? echo $sn ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Other Names (or none) *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="first_name" VALUE="<? echo $fn ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Date Of Birth *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="date_of_birth" VALUE="<? echo $dob ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>UK Residency *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="uk_residency" VALUE="<? echo $uk ?>"/> <OPTION
        value="" selected>-- Please select --</OPTION>
        <OPTION value="From Birth">From Birth</OPTION>
        <OPTION value="1 to 5 Years">1 to 5 Years</OPTION>
        <OPTION value="5 to 10 Years">5 to 10 Years</OPTION>
        <OPTION value="10 or more Years">10 or more Years</OPTION></SELECT>
  <BR></TD></TR>     
 
  <TR>
    <TD class=req vAlign=top align=left>Marital Status *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="marital_status" VALUE="<? echo $ms ?>"/> <OPTION
        value="" selected>-- Please select --</OPTION>
        <OPTION value=Married>Married</OPTION>
        <OPTION value=Single>Single</OPTION></SELECT>
        <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Disability (or None) *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="disability" VALUE="<? echo $d ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Employment Status</TD>
    <TD vAlign=top align=left><SELECT size=1 name="employment_status" VALUE="<? echo $es ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
        <OPTION value="Self Employed">Self Employed</OPTION>
        <OPTION value=Government>Government</OPTION>
        <OPTION value=Other>Other</OPTION></SELECT>
      <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Address Line 1 *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="address_line_1" VALUE="<? echo $ad1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Area *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="area" VALUE="<? echo $a ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Town *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="town" VALUE="<? echo $tn ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>County *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="county" VALUE="<? echo $c ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Post Code *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="post_code" VALUE="<? echo $pc ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Telephone Work *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="daytime_tel_no" VALUE="<? echo $dtn ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Telephone Home *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="evening_tel_no" VALUE="<? echo $etn ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Fax Number *</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>E-Mail *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="email_address" VALUE="<? echo $ee ?>"/>
<BR></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Type of Vehicle - Items in <SPAN class=req>red</SPAN> or
      marked with <SPAN class=req>*</SPAN> are required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Vehicle Make *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="manufacturer" VALUE="<? echo $m ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Vehicle Model *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="model" VALUE="<? echo $mod ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Registration Number *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="reg_no" VALUE="<? echo $reg ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Year Vehicle Registered *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="year_purchased" VALUE="<? echo $yrp?>"/>
    <OPTION value="<? echo $yrp?>" selected>-- Please select --</OPTION>
        <OPTION value=1980>1980</OPTION> <OPTION value=1981>1981</OPTION>
        <OPTION value=1982>1982</OPTION> <OPTION value=1983>1983</OPTION>
        <OPTION value=1984>1984</OPTION> <OPTION value=1985>1985</OPTION>
        <OPTION value=1986>1986</OPTION> <OPTION value=1987>1987</OPTION>
        <OPTION value=1988>1988</OPTION> <OPTION value=1989>1989</OPTION>
        <OPTION value=1990>1990</OPTION> <OPTION value=1991>1991</OPTION>
        <OPTION value=1992>1992</OPTION> <OPTION value=1993>1993</OPTION>
        <OPTION value=1994>1994</OPTION> <OPTION value=1995>1995</OPTION>
        <OPTION value=1996>1996</OPTION> <OPTION value=1997>1997</OPTION>
        <OPTION value=1998>1998</OPTION> <OPTION value=1999>1999</OPTION>
        <OPTION value=2000>2000</OPTION> <OPTION value=2001>2001</OPTION>
        <OPTION value=2002>2002</OPTION> <OPTION value=2003>2003</OPTION>
        <OPTION value=2004>2004</OPTION> <OPTION value=2005>2005</OPTION>
        <OPTION value=2006>2006</OPTION>
        <OPTION value="Another Year">Another Year</OPTION></SELECT>
        <BR></TD></TR>

  <TR>
    <TD vAlign=top align=left>Registration Year if not in 1980 to 2006</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Vehicle Value *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="current_value" VALUE="<? echo $cv ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Seats (including driver) *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="seats_incl_driver" VALUE="<? echo $seats ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Engine Size *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="cubic_capacity" VALUE="<? echo $cc ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Annual Mileage *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="annual_mileage" VALUE="<? echo $am ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Registered Owner *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="registered_owner" VALUE="<? echo $ro ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=Policy Owner>Policy Owner</OPTION>
    <OPTION value=Other>Other</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>If not registered owner please say who is</TD>
    <TD vAlign=top align=left><TEXTAREA name= "if_not_registered_owner_please_supply_name" rows=10 cols=50 VALUE="<? echo $notro ?>"/>
    </TEXTAREA> </TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Overnight Vehicle Location *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="overnight_vehicle_location" VALUE="<? echo $ovl ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value="Garage">Garage</OPTION>
    <OPTION value="On the Road">On the Road</OPTION>
    </SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Electronic Immobiliser</TD>
    <TD vAlign=top align=left><SELECT size=1 name="" VALUE=""> <OPTION
        value="" selected>-- Please select --</OPTION> <OPTION
        value=Yes>Yes</OPTION> <OPTION value=No>No</OPTION></SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Tracking Device Fitted</TD>
    <TD vAlign=top align=left><SELECT size=1 name=F32 VALUE=""> <OPTION
        value="" selected>-- Please select --</OPTION> <OPTION
        value=Yes>Yes</OPTION> <OPTION value=No>No</OPTION></SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>If vehicle 'plated' - Which Council</TD>
    <TD vAlign=top align=left><SELECT size=1 name="licensing_authority" VALUE="<? echo $la ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value="Licensing Authority 1">Licensing Authority 1</OPTION>
    <OPTION value="Licensing Authority 2">Licensing Authority 2</OPTION>
    <OPTION value="Licensing Authority 3">Licensing Authority 3</OPTION>
    </SELECT><BR></TD></TR></TBODY></TABLE>

<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Type of Insurance - Items in <SPAN class=req>red</SPAN>
      or marked with <SPAN class=req>*</SPAN> are required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Type of Cover Required *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="cover_required" VALUE="<? echo $cr ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value="Comprehensive">Comprehensive</OPTION>
    <OPTION value="Third Party Fire and Theft">Third Party Fire and Theft</OPTION>
    <OPTION value="Third Party Only">Third Party Only</OPTION></SELECT>
  <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Class of Use *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="class_of_use" VALUE="<? echo $class ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value="Schools">Schools</OPTION>
    <OPTION value="SDP">SDP</OPTION>
    <OPTION value="Private Hire">Private Hire</OPTION>
    <OPTION value="Public Hire">Public Hire</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Taxi No Claims Bonus *</TD>
    <TD vAlign=top align=left><SELECT size=1 name="type_of_bonus" VALUE="<? echo $tob ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=None>None</OPTION> <OPTION value=1>1</OPTION>
    <OPTION value=2>2</OPTION> <OPTION value=3>3</OPTION>
    <OPTION value=4>4</OPTION> <OPTION value=5>5</OPTION>
    <OPTION value=6>6</OPTION> <OPTION value=Maximam>Maximam</OPTION>
    <OPTION value="Not Applicable">Not Applicable</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Cover Start Date *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="policy_start_date" VALUE="<? echo $psd ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Previous Insurers</TD>
    <TD vAlign=top align=left><INPUT size=45 name="current_previous_insurer" VALUE="<? echo $cpi ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Previous Brokers</TD>
    <TD vAlign=top align=left><INPUT size=45 name="current_previous_insurance_broker" VALUE="<? echo $cpib ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Target Premium</TD>
    <TD vAlign=top align=left><INPUT size=45 name="target_premium" VALUE="<? echo $tp ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Quoted By</TD>
    <TD vAlign=top align=left><INPUT size=45 name="who_quoted" VALUE="<? echo $wq ?>"/>
    <BR></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Previous Claims(first) - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD vAlign=top align=left>Claim 1 Details</TD>
    <TD vAlign=top align=left><INPUT size=45 name="">
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Date of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_1_date" VALUE="<? echo $cd1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Type of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Fault Claim</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_1_fault" VALUE="<? echo $cf1 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Repair Cost</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_1_repair_cost" VALUE="<? echo $crc1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Bonus Affected</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_1_effect_on_NCB" VALUE="<? echo $ncb1 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Previous Claims(second) - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD vAlign=top align=left>Claim 2 Details</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Date of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_date" VALUE="<? echo $cd2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Type of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_type" VALUE="<? echo $ct2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Fault Claim</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_2_fault" VALUE="<? echo $cf2 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Repair Cost</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_repair_cost" VALUE="<? echo $crc2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Bonus Affected</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_2_effect_on_NCB" VALUE="<? echo $ncb2 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION></SELECT>
    <BR></TD></TR></TBODY></TABLE>   

<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>License details main driver - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD vAlign=top align=left>Policy Holder License Type for main driver</TD>
    <TD vAlign=top align=left><SELECT size=1 name="licence_type" VALUE="<? echo $lt ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value="UK Full">UK Full</OPTION>
    <OPTION value=Provisional>Provisional</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Years License Held</TD>
    <TD vAlign=top align=left><SELECT size=1 name="years_held" VALUE="<? echo $yh ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=1>1</OPTION> <OPTION value=2>2</OPTION>
    <OPTION value=3>3</OPTION> <OPTION value=4>4</OPTION>
    <OPTION value=5>5</OPTION> <OPTION value=6>6</OPTION>
    <OPTION value=7>7</OPTION> <OPTION value=8>8</OPTION>
    <OPTION value=9>9</OPTION> <OPTION value=10>10</OPTION>
    <OPTION value=11>11</OPTION> <OPTION value=12>12</OPTION>
    <OPTION value=13>13</OPTION> <OPTION value=14>14</OPTION>
    <OPTION value=5>15</OPTION> <OPTION value=16>16</OPTION>
    <OPTION value=17>17</OPTION> <OPTION value=18>18</OPTION>
    <OPTION value=19>19</OPTION> <OPTION value=20>20</OPTION>
    <OPTION value="Greater than 20">Greater than 20</OPTION>
    <OPTION value="Less than 1">Less than 1</OPTION></SELECT>
    <BR></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>License details additional driver 1 - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Name of additional driver 1 (or none)
    *</TD>
    <TD vAlign=top align=left><INPUT size=45 name="additional_driver_1_name" VALUE="<? echo $ad1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Date Of Birth of additional driver 1
      (or none) *</TD>
    <TD vAlign=top align=left><INPUT size=45 name=F57> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Policy Holder License Type for additional driver
      1</TD>
    <TD vAlign=top align=left><SELECT size=1 name=F58 VALUE=""> <OPTION
        value="" selected>-- Please select --</OPTION> <OPTION
        value="UK Full">UK Full</OPTION> <OPTION
        value=Provisional>Provisional</OPTION></SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Years License Held</TD>
    <TD vAlign=top align=left><SELECT size=1 name="additional_driver_1_licence_years_held" VALUE="<? echo $adyh1 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=1>1</OPTION> <OPTION value=2>2</OPTION>
    <OPTION value=3>3</OPTION> <OPTION value=4>4</OPTION>
    <OPTION value=5>5</OPTION> <OPTION value=6>6</OPTION>
    <OPTION value=7>7</OPTION> <OPTION value=8>8</OPTION>
    <OPTION value=9>9</OPTION> <OPTION value=10>10</OPTION>
    <OPTION value=11>11</OPTION> <OPTION value=12>12</OPTION>
    <OPTION value=13>13</OPTION> <OPTION value=14>14</OPTION>
    <OPTION value=5>15</OPTION> <OPTION value=16>16</OPTION>
    <OPTION value=17>17</OPTION> <OPTION value=18>18</OPTION>
    <OPTION value=19>19</OPTION> <OPTION value=20>20</OPTION>
    <OPTION value="Greater than 20">Greater than 20</OPTION>
    <OPTION value="Less than 1">Less than 1</OPTION></SELECT>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Convictions over last three years</TD>
    <TD vAlign=top align=left><TEXTAREA name=F60 rows=10 cols=50 VALUE=""></TEXTAREA>
  </TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>License details additional driver 2 - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Name of additional driver 2 (or NONE)
    *</TD>
    <TD vAlign=top align=left><INPUT size=45 name=F61> <BR></TD></TR>
  <TR>
    <TD class=req vAlign=top align=left>Date Of Birth of additional driver 2
      (or none) *</TD>
    <TD vAlign=top align=left><INPUT size=45 name=F62> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Policy Holder License Type for additional driver
      2</TD>
    <TD vAlign=top align=left><SELECT size=1 name=F63 VALUE=""> <OPTION
        value="" selected>-- Please select --</OPTION> <OPTION
        value="UK Full">UK Full</OPTION> <OPTION
        value=Provisional>Provisional</OPTION></SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Years License Held</TD>
    <TD vAlign=top align=left><SELECT size=1 name=F64 VALUE=""> <OPTION
        value="" selected>-- Please select --</OPTION> <OPTION
        value=1>1</OPTION> <OPTION value=2>2</OPTION> <OPTION value=3>3</OPTION>
        <OPTION value=4>4</OPTION> <OPTION value=5>5</OPTION> <OPTION
        value=6>6</OPTION> <OPTION value=7>7</OPTION> <OPTION value=8>8</OPTION>
        <OPTION value=9>9</OPTION> <OPTION value=10>10</OPTION> <OPTION
        value=11>11</OPTION> <OPTION value=12>12</OPTION> <OPTION
        value=13>13</OPTION> <OPTION value=14>14</OPTION> <OPTION
        value=5>15</OPTION> <OPTION value=16>16</OPTION> <OPTION
        value=17>17</OPTION> <OPTION value=18>18</OPTION> <OPTION
        value=19>19</OPTION> <OPTION value=20>20</OPTION> <OPTION
        value="Greater than 20">Greater than 20</OPTION> <OPTION
        value="Less than 1">Less than 1</OPTION></SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Convictions over last three years</TD>
    <TD vAlign=top align=left><TEXTAREA name=F65 rows=10 cols=50 VALUE=""></TEXTAREA>
  </TD></TR></TBODY></TABLE>
<P><INPUT type=submit value="Submit Request" name=""> <INPUT type=reset value="Cancel"> </P></FORM>
<HR>

When I submit the page it comes up with this message:

You are not authorized to view this page
You might not have permission to view this directory or page using the credentials you supplied.

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

If you believe you should be able to view this directory or page, please try to contact the Web site by using any e-mail address or phone number that may be listed on the localhost home page.

You can click  Search to look for information on the Internet.




HTTP Error 403 - Forbidden
Internet Explorer 

Can anybody help?

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I have now changed it to this:

<META content="MSHTML 6.00.2800.1458" name=GENERATOR></HEAD>
<BODY bgColor=#99ccff>
<DIV><B>GSI Insurance LTD</B> (Claim History Page)</DIV>
<HR>
<STYLE>.req {
COLOR: #ff0033
}
</STYLE>

<?

if ($_POST) {

  $msg = "";

  foreach($_POST as $k => $v) {
        $v = trim($v);
        $$k = $v;

        if ($v=="") {
          $msg = "Please fill in all fields";
        }
  }

  if ($msg=="") {
      $insert = "INSERT INTO claim_history
        (claim_1_date, claim_1_fault, claim_1_type,
        claim_1_repair_cost, claim_1_effect_on_NCB, claim_2_date, claim_2_fault,
        claim_2_type, claim_2_repair_cost, claim_2_effect_on_NCB)
        VALUES ( '$cd1', '$cf1', '$ct1', '$crc1','$ncb1', '$cd2', '$cf2', '$ct2',
        '$crc2', '$ncb2')";

        include 'includes/db_conn.txt';
       
        if (!mysqli_query($link, $insert)) {
          $msg = "Error inserting data";
        } else {
          $msg = "Record succesfully added";

        $cd1= $cf1 = $ct1 = $crc1 = $ncb1 = $cd2 = $cf2 = $ct2 = $crc2 = $ncb2 = "";
        }
        mysqli_close($link);
  }     

echo "<div class=\"error\">$msg</div>";

} else {
      $cd1= $cf1 = $ct1 = $crc1 = $ncb1 = $cd2 = $cf2 = $ct2 = $crc2 = $ncb2 = "";
}
?>

<FORM METHOD="post" ACTION="<? echo $SERVER['PHP_SELF'] ?>">
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Personal Details Items in <SPAN class=req>red</SPAN> or
      marked with <SPAN class=req>*</SPAN> are required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
 
  <TD colSpan=2><B>Previous Claims(first) - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD vAlign=top align=left>Claim 1 Details</TD>
    <TD vAlign=top align=left><INPUT size=45 name="">
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Date of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_1_date" VALUE="<? echo $cd1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Type of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Fault Claim</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_1_fault" VALUE="<? echo $cf1 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Repair Cost</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_1_repair_cost" VALUE="<? echo $crc1 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Bonus Affected</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_1_effect_on_NCB" VALUE="<? echo $ncb1 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR></TBODY></TABLE>
<TABLE cellSpacing=0 cellPadding=5 border=0>
  <TBODY>
  <TR>
    <TD colSpan=2><B>Previous Claims(second) - Items in <SPAN
      class=req>red</SPAN> or marked with <SPAN class=req>*</SPAN> are
      required.</B></TD></TR>
  <TR>
    <TD colSpan=2>&nbsp;</TD></TR>
  <TR>
    <TD vAlign=top align=left>Claim 2 Details</TD>
    <TD vAlign=top align=left><INPUT size=45 name=""> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Date of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_date" VALUE="<? echo $cd2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Type of Claim</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_type" VALUE="<? echo $ct2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Fault Claim</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_2_fault" VALUE="<? echo $cf2 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION>
    </SELECT> <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Repair Cost</TD>
    <TD vAlign=top align=left><INPUT size=45 name="claim_2_repair_cost" VALUE="<? echo $crc2 ?>"/>
    <BR></TD></TR>
  <TR>
    <TD vAlign=top align=left>Bonus Affected</TD>
    <TD vAlign=top align=left><SELECT size=1 name="claim_2_effect_on_NCB" VALUE="<? echo $ncb2 ?>"/>
    <OPTION value="" selected>-- Please select --</OPTION>
    <OPTION value=No>No</OPTION> <OPTION value=Yes>Yes</OPTION></SELECT>
    <BR></TD></TR></TBODY></TABLE>   
   
    <P><INPUT type=submit value="Submit Request" name=""> <INPUT type=reset value="Cancel"> </P></FORM>

But I still have the same problem saying:

'You are not authorized to view this page
You might not have permission to view this directory or page using the credentials you supplied.

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

If you believe you should be able to view this directory or page, please try to contact the Web site by using any e-mail address or phone number that may be listed on the localhost home page.

You can click  Search to look for information on the Internet.




HTTP Error 403 - Forbidden
Internet Explorer '

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What am I doing wrong?

As the response after the submission of the form, the next page states that I am not authorized to view the page?

Somebody please help.

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