PHP contact form problems

[kristina]

I have a contact form that I want to send to my email. this is the code for the form:

<form method="post" action="contact_us.php" enctype="multipart/form-data" accept-charset="UTF-8">
  <p><img src="assets/images/Notes_rule_small.jpg" alt="notes" width="388" height="23" id="Image2"></p>
  <p class="style5"> </p>
  <p class="style5">Please Complete the Form Below and We Will Get Back to You Very Soon!</p>
  <p class="style5"><span class="text"><br>
    </span><span class="style21">* Indicates a required field.</span></p>
  <p class="style5"><span class="NEW">WE ARE CURRENTLY WORKING ON OUR CONTACT FORMS..<br>
PLEASE EMAIL US AT <a href="mailto:leydigital@hotmail.com">leydigital@hotmail.com</a> WITH YOUR QUESTIONS/INFORMATION</span><br>
    <br>
    <br>
  </p>
  <table border="0" align="center" cellpadding="2" cellspacing="0" bgcolor="#FFFFFF">
    <tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">* Full Name</font></td> 
  <td><input type="text" name="FieldData0" size="40">
    <br>
    <br></td></tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">* Email Address</font></td> 
    <td><input name="FieldData1" type="text" size="40">
      <br>
      <span class="text">Please make sure you typed it correctly.    </span><br>
    <br></td>
    </tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">Phone Number</font></td> 
    <td><input type="text" name="FieldData2" size="40">
    <br>
    <br></td></tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">Preferred Contact Method</font></td> 
    <td><input type=checkbox name="FieldData3-0" value="Phone" id="check30"><font face="Verdana" size="2" color="#000000"><label for="check30">Phone</label></font><br>
    <input type=checkbox name="FieldData3-1" value="Email" id="check31"><font face="Verdana" size="2" color="#000000"><label for="check31">Email</label></font><br>
    <input type=checkbox name="FieldData3-2" value="Carrier Pigeon" id="check32"><font face="Verdana" size="2" color="#000000"><label for="check32">Carrier Pigeon</label></font><br>
    <input type=checkbox name="FieldData3-3" value="ESP" id="check33"><font face="Verdana" size="2" color="#000000"><label for="check33">ESP</label></font><br>
    <br> </td></tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">* Type of Event</font></td> 
    <td><input type="text" name="FieldData4" size="40">
    <br>
    <br></td></tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">* Event Location</font></td> 
    <td><textarea name="FieldData5" cols="35" rows="6"></textarea>
        <br>        <br> </td></tr><tr valign="top"> <td align="right" nowrap><font face="Verdana" size="2" color="#000000">* Event Date</font></td> 
        <td><input type="text" name="FieldData6" size="40">
        <br>
<br></td></tr><tr valign="top"> <td nowrap><font face="Verdana" size="2" color="#000000">* How Did You Hear About Us?</font></td> <td>
<select name="FieldData7"><option value="Grace Referral">Grace Referral</option>
<option value="Matt Referral">Matt Referral</option>
<option value="Friend Referral">Friend Referral</option>
<option value="Wedding Site">Wedding Site</option>
<option value="Google">Google</option>
<option value="Yahoo">Yahoo</option>
<option value="Bing">Bing</option>
<option value="Facebook">Facebook</option>
<option value="Other">Other</option>
<option value="" selected></option>
</select>    <br>
  <br>
  <span class="text">If you found us through a wedding website or some other method,<br>
    please indicate which one below with your message, thanks!</span><br> </td>
</tr> 
<td align="right" valign="top" nowrap><font face="Verdana" size="2" color="#000000">* Message</font></td> 
<td><textarea name="FieldData8" cols="35" rows="7"></textarea>
      <br>      <br> </td></tr><tr> <td colspan="2"><table cellpadding=5 cellspacing=0 bgcolor="#CCCCCC" width="100%"><tr bgcolor="#666666"><td colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td></tr><tr><td width="175" align="right" style="padding: 2px;"><img src="http://www.emailmeform.com/turing.php" id="captcha"></td><td width="270" valign="top" bgcolor="#999999" class="style35"><font color="#000000">Please enter the text from the image</font>   <br>
      <input type="text" name="Turing" value="" maxlength="100" size="10"> 
    [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ]</td></tr></table></td></tr><tr> <td> </td> <td align="left">
    <input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
    <input type="submit" class="btn" value="Submit" name="Submit">   
     <input type="reset" class="btn" value="Clear Form" name="Clear"></td></tr><tr><td colspan=2 align="center"><p> </p>
        <p><br>
      </p></td></tr></table></form>

 

and for the action page: contact_us.php

 <?php
// Validate the name and combat Magic Quotes, if necessary.
if (!empty($_REQUEST['FieldData0'])) {
   $name = stripslashes($_REQUEST['FieldData0']);
} else {
   $name = NULL;
echo '<p><font color="red">Please enter your name!</font></p>';
}

// Validate the email and combat Magic Quotes, if necessary.
if (!empty($_REQUEST['FieldData1'])) {
   $email = $_REQUEST['FieldData1'];
} else {
   $email = NULL;
echo '<p><font color="red">Please enter your email address!</font></p>';
}

// If everything was filled out, print the message.
if ($name && $email) {

   echo "<center>Thank you, <b>$name</b>.</center>"; 
   
} else { // One form element was not filled out properly.
   echo '<p><font color="red">Please go back and fill out the form again.   
   </font></p>';
}
echo '<br><br><br><br><br><br><br><br><br><br><br><br><br><br>';
ob_start();
// The message
$message = "";
$subject = "Contact Form";
$to = "kristinakent@gmsil.com";
$headers .= 'From: Ley Digital Music' . "\r\n";

$message .=  $_REQUEST['hFieldData0'] . " " . $_REQUEST['FieldData0'] . "\n";
$message .=  $_REQUEST['hFieldData1'] . " " . $_REQUEST['FieldData1'] . "\n";
$message .=  $_REQUEST['hFieldData2'] . " " . $_REQUEST['FieldData2'] . "\n";
$message .=  $_REQUEST['hFieldData3-0'] . " " . $_REQUEST['FieldData3-0'] . "\n";
$message .=  $_REQUEST['hFieldData3-1'] . " " . $_REQUEST['FieldData3-1'] . "\n";
$message .=  $_REQUEST['hFieldData3-2'] . " " . $_REQUEST['FieldData3-2'] . "\n";
$message .=  $_REQUEST['hFieldData3-3'] . " " . $_REQUEST['FieldData3-3'] . "\n";
$message .=  $_REQUEST['hFieldData4'] . " " . $_REQUEST['FieldData4'] . "\n";
$message .=  $_REQUEST['hFieldData5'] . " " . $_REQUEST['FieldData5'] . "\n";
$message .=  $_REQUEST['hFieldData6'] . " " . $_REQUEST['FieldData6'] . "\n";
$message .=  $_REQUEST['hFieldData7'] . " " . $_REQUEST['FieldData7'] . "\n";

// In case any of our lines are larger than 70 characters, we should use wordwrap()
$message = wordwrap($message, 70);

// Send
$ret = mail($to, $subject, $message);
echo '<br><br>';

?> 

 

That's as far as I got, I don't know how to do the dropdown menu options on the contact_us.php page. Can anyone help? And I would like to make this more secure.

[RussellReal]

more secure how? also.. drop downs are super easy.. <select name="whatever"><option>lol</option></select>

 

I added u to MSN at this email: leydigital@hotmail.com I'll gladly help you out just accept me

[kristina]

I need to know how to code it on the php response page, contact_us.php. As you can see I already have it coded in the html form on contact_us.html. and that is not my email address, this is for a client of mine. my email address is krazykrisi@hotmail.com