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Good afternoon! I will apologize upfront, because I am a complete novice when it comes to PHP. I know enough to really mess things up.

 

So, I have inherited a PHP form that writes to MySQL table, then submits to Marketo and gets passed along to Salesforce. The programmer who wrote it, is no longer available and I need to change some of the code. In a nutshell, I have a hidden field (Primary Interest) that populates it's value based on a variable ($serviceLine) that gets entered when a new record is inserted into the table. I need to create a dropdown select that writes to a variable ($interest) for my form, then use that variable to populate Primary Interest, or default to $serviceLine if $interest is not present or NULL.

 

Thanks in advance.

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Your can create a dropdown using <select> the populate the menu with choices using <option>. Example html

<select name="intrest">                     <!-- name attribute defines the name of the input -->
   <option value="">Choose Intrest</option>
   <option value="value1">Option 1</option>
   <option value="value2">Option 2</option>
   <option value="value3">Option 3</option>
   .. etc
</select>

If you include that html into your form you should be able to get the selected options value using $_POST['interest'];

$intrest = $_POST['intrest'];

 

or default to $serviceLine if $interest is not present or NULL.

Using the example code above you could do

$intrest = (isset($_POST['intrest']) && $_POST['intrest'] != '') ? $_POST['intrest'] : $serviceLine; // default to $serviceLine if no interest was selected
Edited by Ch0cu3r
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Well, it didn't break anything, but it doesn't look like the variable came through. In an effort to show you what I am working with, here's the PHP with the sensitive bits removed. I drop a PHP include inside a module on the pages that I want, then I go to PHPmyAdmin and INSERT a new entry into the table. The PHP populates the Module with the correct template. Within this code I need to add my dropdown field, write it to a variable, and use some sort of IF ELSE logic to populate my Primary Interest.

<?php function getFormType($form){?>
	<?php /* DONT PUT ANYTHING ABOVE THIS POINT */ ?>
	

	<?php if($form->form_type == 'download'){ ?>
		<?php $form->startForm(); ?>
		
				<h2><?php echo $form->headerText; ?></h2>
				<?php echo $form->topContent; ?>
				<?php echo $form->firstName;?>
				<?php echo $form->lastName; ?>
				<?php echo $form->company; ?>
				<?php echo $form->email; ?>
				<?php echo $form->phone; ?>
				<?php $form->hiddenFields(); ?>
				<?php echo $form->demo; ?>
				<?php echo $form->pricing; ?>
				<?php echo $form->emailSubscriptions; ?>
				<?php echo $form->submitButton; ?>
			
		<?php $form->endForm(); ?>	
	<?php } ?>


	<?php if($form->form_type == 'tradeshow'){ ?>
		<?php $form->startForm(); ?>
		
				<h2><?php echo $form->headerText; ?></h2>
				<?php echo $form->topContent; ?>
				<?php echo $form->firstName;?>
				<?php echo $form->lastName; ?>
				<?php echo $form->company; ?>
				<?php echo $form->email; ?>
				<?php echo $form->phone; ?>
				<?php echo $form->commentBox; ?>
				<?php $form->hiddenFields(); ?>
				<?php echo $form->demo; ?>
				<?php echo $form->pricing; ?>
				<?php echo $form->emailSubscriptions; ?>
				<br /><?php echo $form->submitButton; ?>
			
		<?php $form->endForm(); ?>	
	<?php } ?>
	
	

	<?php if($form->form_type == 'contact'){ ?>
		<?php $form->startForm(); ?>
		
				<?php echo $form->headerText; ?>
				<?php echo $form->topContent; ?>
				
				<div class='column-one' style='width:34%;'>
				<?php echo $form->firstName;?>
				<?php echo $form->lastName; ?>
				<?php echo $form->title; ?>
				<?php echo $form->phone; ?>
				<?php echo $form->email; ?>
				
				
				</div>
				
				<div class='column-two' style='width:33%;'>
				
				
				
				<?php echo $form->company; ?>
				<?php echo $form->address; ?>
				<?php echo $form->state; ?>
				<?php echo $form->phoneExt; ?><br />

				</div>
				<div class='column-three' style='width:33%;'>
				<?php echo $form->commentBox; ?><br />
				<?php $form->hiddenFields(); ?>
				<?php echo $form->demo; ?>
				<?php echo $form->pricing; ?>
				<?php echo $form->emailSubscriptions; ?>
				</div>
					
				<?php echo $form->submitButton; ?>
			
		<?php $form->endForm(); ?>	
	<?php } ?>
	
	
		
	<?php /*
	 * 
	 * 
	 * 
	 * 
		Steps to making a new form template:
	 * 1) Make a COPY of the following code, and paste it above in an empty line
	 * 2) Enter a name where indicated making sure that the name is enclosed in single apostophes (e.g. 'myform')
	 * 3) Remove any form fields that you don't wish to have on the form -- you MUST NOT REMOVE startForm, hiddenFields, submitButton, or endForm
	 * 4) Demo and Pricing MUST COME AFTER hiddenFields, or the form will not work!
	 * 5) Profit 
	*/ ?>
	<?php /* START COPYING HERE*/ ?>
	<?php if($form->form_type == '*************CHANGE THIS TO THE NAME YOU WANT TO USE AS FORM TEMPLATE*************'){ ?>
		<?php $form->startForm(); ?>
		<?php /*REMOVE THE FIELDS YOU DON'T WANT IN YOUR FORM AND ADD HTML WHERE NEEDED*/ ?>
				<?php echo $form->headerText; ?>
				<?php echo $form->topContent; ?>
				<?php echo $form->firstName;?>
				<?php echo $form->lastName; ?>
				<?php echo $form->title; ?>
				<?php echo $form->email; ?>
				<?php echo $form->phone; ?>
				<?php echo $form->phoneExt; ?>
				<?php echo $form->company; ?>
				<?php echo $form->address; ?>
				<?php echo $form->state; ?>
				<?php echo $form->commentBox; ?>
				<?php $form->hiddenFields(); ?>
				<?php echo $form->demo; ?>
				<?php echo $form->pricing; ?>
				<?php echo $form->emailSubscriptions; ?>
				<?php echo $form->submitButton; ?>
			</div>
		<?php $form->endForm(); ?>	
	<?php } ?>
	<?php /* STOP COPYING HERE */ ?>
	
	<?php /* DONT PUT ANYTHING BELOW THIS POINT */ ?>
<?php } ?>





<?php mortyForm(); ?>

<?php
Class Form {
	public $firstName =
	"<span id='FirstNameSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				First Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='FirstName' id='FirstName' size='' type='text' value=''  maxlength='255' tabIndex='1' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>";
	public $lastName = 
	"<span id='LastNameSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Last Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='LastName' id='LastName' size='23' type='text' value=''  maxlength='255' tabIndex='2' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $email = "
		<span id='EmailSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Email
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormEmail mktFReq' name='Email' id='Email' size='23' type='text' value=''  maxlength='255' tabIndex='5' />
				<span class='mktFormMsg'></span>
			</span>
		</span>
	";
	public $phone = "
		<span id='PhoneTable' class='uk-form-row'>
			<label class='uk-form-label'>
				Phone Number
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormPhone' name='Phone' id='Phone' size='23' type='text' value=''  maxlength='255' tabIndex='3' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $title = "
		<span id='TitleSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Title
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString' name='Title'  size='23'  type='text' value=''  maxlength='255' tabIndex='4' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $phoneExt = "
		<label class='uk-form-label' class='uk-form-row'>
			Phone Ext.
		</label><br />
		<span class='mktInput'>
			<input class='mktFormText mktFormString' name='Phone_Extension__c' id='Phone_Extension__c' size='23'  type='text' value=''  maxlength='8' tabIndex='9' />
			<span class='mktFormMsg'></span>
		</span>
	";
	public $company = "
		<span id='CompanySpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Facility Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='Company' size='23' id='Company' type='text' value=''  maxlength='255' tabIndex='6' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $address = "
		<span id='AddressSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Street Address
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='Address' size='23'  id='Address' type='text' value=''  maxlength='255' tabIndex='7' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $state = "
		<span id='StateTable' class='uk-form-row'>
			<label class='uk-form-label'>
				Zip
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='PostalCode' id='PostalCode' size='23'  type='text' value=''  maxlength='255' tabIndex='8' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $submitButton = "<br /><input id='mktFrmSubmit' class='cta-button' type='button' style='margin-left:200px; width: 100px; overflow: visible; padding-left: .25em; padding-right: .25em; margin-top:60px; font-size:14px' name='submitButton' value='Submit' return false; />";
	public $form_type = 'test';
	public $followUpLevel;
	public $requestSubject;
	public $retURL;
	public $autoResponder;
	public $headerText;
	public $topContent;
	public $commentBox;
	public $primaryInterest;
	public $serviceLine;
	public $demo;
	public $pricing;
	public $emailSubscriptions;
	
	function SetAll($form_type, $followUpLevel, $requestSubject, $retURL, $autoResponder, $headerText, $topContent, 
					$commentBox, $primaryInterest, $serviceLine, $demo, $pricing, $emailSubscriptions){
		$this->form_type = $form_type;
		$this->followUpLevel = $followUpLevel;
		$this->requestSubject = $requestSubject;
		$this->retURL = $retURL;
		$this->autoResponder = $autoResponder;
		$this->headerText = $headerText;
		$this->topContent = $topContent;
		$this->commentBox = $commentBox;
		$this->primaryInterest = $primaryInterest;
		$this->serviceLine = $serviceLine;
		$this->demo = $demo;
		$this->pricing = $pricing;
		$this->emailSubscriptions = $emailSubscriptions;
	}

	function startForm(){ ?>
		<script src='http://ajax.googleapis.com/ajax/libs/jquery/1.7.2/jquery.min.js' type='text/javascript'></script>
		<script type='text/javascript' src='http://xxxxxxx.com/js/formfunctions.js'></script>
		<form id='mktForm_1006' class='lpeRegForm formNotEmpty' action='http://app-o.marketo.com/index.php/leadCapture/save' method='post' name='mktForm_1006' enctype='application/x-www-form-urlencoded'>
				<script type='text/javascript'> function mktoGetForm() {return document.getElementById('mktForm_1006'); }</script>
	<?php } 
	function endForm(){ ?>
		<span style='display:none;'><input type='text' name='_marketo_comments' value='' /></span>
	  	<input type='hidden' name='lpId' value='1050' />
	  	<input type='hidden' name='subId' value='17' />
		<input type='hidden' name='kw' value='' />
		<input type='hidden' name='cr' value='' />
		<input type='hidden' name='searchstr' value='' />
		<input type='hidden' name='lpurl' value='http://na-o.marketo.com/lp/xxxxxx/GenericForm.html?cr={creative}&kw={keyword}' />
		<input type='hidden' name='formid' value='1006' />
		<input type='hidden' name='_mkt_disp' value='return' />
		<input type='hidden' name='_mkt_trk' value='id:596-FKF-634&token:_mch-xxxxxxx.com-1330369410817-92622' />
		<script type='text/javascript' src='http://na-o.marketo.com/js/mktFormSupport.js'></script>
		<script type='text/javascript'>
		function formSubmit(elt) {
			return Mkto.formSubmit(elt);
		}
		function formReset(elt) {
			return Mkto.formReset(elt);
		}
		</script>
		</form>
	<?php }
	function hiddenFields(){
	$requestSubject = $this->requestSubject;
	$intrest = (isset($_POST['intrest']) && $_POST['intrest'] != '') ? $_POST['intrest'] : $serviceLine;
	$serviceLine = $this->serviceLine;
	$followUpLevel = $this->followUpLevel;
	$retURL = $this->retURL;
	$autoResponder = $this->autoResponder;
	?>
		<input name='Request_Name' id='Request_Name' class='requestinfo' type='hidden' value="<?php echo $requestSubject; ?>"  maxlength='255'/>
		<input name='Request_Type' id='Request_Type' class='requestinfo' type='hidden' value='Web'  maxlength='255'/>
		<input name='Primary_Interest' id='Primary_Interest' class='requestinfo' type='hidden' value="<?php echo $interest; ?>"  maxlength='255'/>
		<input name='Follow_Up_Level' id='Follow_Up_Level' class='requestinfo' type='hidden' value="<?php echo $followUpLevel; ?>" maxlength='255'/>
		<input name='Hide_Request_Info__c' id='Hide_Request_Info__c' maxlength='1500' type='hidden'>
		<input name='Hide_Cookie_Info__c' id='Hide_Cookie_Info__c' maxlength='1500' type='hidden'>
		<input name='Hide_Form_Comments__c' id='Hide_Form_Comments__c' class='' maxlength='1500' type='hidden'>
		<input type='hidden' id='returnURL' name='returnURL' value="<?php echo $retURL; ?>"/>
		<input type='hidden' id='retURL' name='retURL' value="<?php echo $retURL; ?>" />
		<input name='Auto_Responder__c' id='Auto_Responder__c' type='hidden' value="<?php echo $autoResponder;?>" />
	<?php } 					
}
?>


<?php  
	function mortyForm(){
		/* set the connection and login credentials to MYSQL */
		$con = mysql_connect("localhost","user","password");
		if (!$con){
			die('Could not connect: ' . mysql_error());
		}
		
		/* Connect to to MYSQL database */	
		mysql_select_db("database_table", $con);
		
		/* set the slug variable that will select the row from the database (the if statemenet handles if there are extra params in the url) */
		$slug2 = 'http://www.'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"];
		$slug = 'http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"];
		if(strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '/?') || strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?')){
			$slug = substr('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], 0, strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?'));
			$slug2 = substr('http://www.'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], 0, strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?'));
		}
	 	
	 	
		/* set the query to return matching rows */
		$result = mysql_query("SELECT * FROM uber_forms WHERE page_url = '".$slug."' or page_url = '".$slug2."'");
		
		while ($row = mysql_fetch_array($result)){
			$form_type = $row['form_type'];
			$followUpLevel = $row['followup_level'];
			$requestSubject = $row['request_subject'];
			$retURL = $row['returl'];
			$autoResponder = $row['autoresponder'];
			$headerText = $row['header'];
			$primaryInterest = $row['primary_interest'];
			$serviceLine = $row['service_line'];
			$emailSubscriptions = $row['email_subscription'];
			if($row['demo'] == 1 && $row['pricing'] == 1){
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo chk' type='checkbox' value='false' />I want to schedule a demo<br />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo chk' type='checkbox' value='false' />I want information on pricing<br />";
			}
			else if($row['pricing'] == 1){
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo' type='hidden' value='true' />";
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo' type='hidden' value='false' />";
			}
			else if($row['demo'] == 1){
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo' type='hidden' value='true' />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo' type='hidden' value='false' />";
			}
			else{
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo chk' type='hidden' value='false' />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo chk' type='hidden' value='false' />";
			}
			
			$commentBox = "<label>".$row['comment_box']."</label>";
			
			if($row['top_content'] != NULL){
				$topContent = "<div class='top-content'>".$row['top_content']."</div>";
			}
			
			/* if the comment_box column has any characters in it at all (including blanks) set the commentbox var to the textarea */
			if($row['comment_box'] != NULL){
				$commentBox .= "<textarea class='mktFormText mktFormString formcomments' id='Comment_Question__c' name='Comment_Question__c'></textarea>";
			}
			else{
				$commentBox = NULL;
			}
			
		}
		$form = new Form;
		$form->SetAll($form_type, $followUpLevel, $requestSubject, $retURL, $autoResponder, $headerText, $topContent, $commentBox, $primaryInterest, $serviceLine, $demo, $pricing, $emailSubscriptions);
		getFormType($form);
		mysql_close($con);
	}
?>
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I am including the dropdown list in the table. I add the HTML in the comment field and it generates the list. I think the javascript that gets called passes that input and the comments into one field in Marketo that is separated by semicolons. Then some other custom-built piece of Salesforce programming takes that field and splits it back up into different fields in Salesforce. I hadn't even considered the fact that the dropdown was being swept up in that javascript. This is why the whole thing is so confusing.

 

So, I need to create a field for the dropdown and then include it in the template?

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Here's my revised code. The dropdown is not showing up on the page.

<?php function getFormType($form){?>
	<?php /* DONT PUT ANYTHING ABOVE THIS POINT */ ?>
	

	<?php if($form->form_type == 'mediwarecontact'){ ?>
		<?php $form->startForm(); ?>
		<?php /*REMOVE THE FIELDS YOU DON'T WANT IN YOUR FORM AND ADD HTML WHERE NEEDED*/ ?>
				<?php echo $form->headerText; ?>
				<?php echo $form->topContent; ?>
				
				<div class='column-one' style='width:34%;'>
				<?php echo $form->firstName;?>
				<?php echo $form->lastName; ?>
				<?php echo $form->title; ?>
				<?php echo $form->phone; ?>
				<?php echo $form->email; ?>
				
				
				</div>
				
				<div class='column-two' style='width:33%;'>
				
				
				
				<?php echo $form->company; ?>
				<?php echo $form->address; ?>
				<?php echo $form->state; ?>
				<?php echo $form->phoneExt; ?><br />

				</div>
				<div class='column-three' style='width:33%;'>
				<?php echo $form->interest; ?>
				<?php echo $form->commentBox; ?><br />
				<?php $form->hiddenFields(); ?>
				<?php echo $form->demo; ?>
				<?php echo $form->pricing; ?>
				<?php echo $form->emailSubscriptions; ?>
				</div>
					
				<?php echo $form->submitButton; ?>
			
		<?php $form->endForm(); ?>	
	<?php } ?>
	
<?php } ?>



<?php mortyForm(); ?>

<?php
Class Form {
	public $firstName =
	"<span id='FirstNameSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				First Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='FirstName' id='FirstName' size='' type='text' value=''  maxlength='255' tabIndex='1' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>";
	public $lastName = 
	"<span id='LastNameSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Last Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='LastName' id='LastName' size='23' type='text' value=''  maxlength='255' tabIndex='2' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $email = "
		<span id='EmailSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Email
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormEmail mktFReq' name='Email' id='Email' size='23' type='text' value=''  maxlength='255' tabIndex='5' />
				<span class='mktFormMsg'></span>
			</span>
		</span>
	";
	public $phone = "
		<span id='PhoneTable' class='uk-form-row'>
			<label class='uk-form-label'>
				Phone Number
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormPhone' name='Phone' id='Phone' size='23' type='text' value=''  maxlength='255' tabIndex='3' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $title = "
		<span id='TitleSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Title
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString' name='Title'  size='23'  type='text' value=''  maxlength='255' tabIndex='4' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $phoneExt = "
		<label class='uk-form-label' class='uk-form-row'>
			Phone Ext.
		</label><br />
		<span class='mktInput'>
			<input class='mktFormText mktFormString' name='Phone_Extension__c' id='Phone_Extension__c' size='23'  type='text' value=''  maxlength='8' tabIndex='9' />
			<span class='mktFormMsg'></span>
		</span>
	";
	public $company = "
		<span id='CompanySpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Facility Name
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='Company' size='23' id='Company' type='text' value=''  maxlength='255' tabIndex='6' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $address = "
		<span id='AddressSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Street Address
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='Address' size='23'  id='Address' type='text' value=''  maxlength='255' tabIndex='7' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $state = "
		<span id='StateTable' class='uk-form-row'>
			<label class='uk-form-label'>
				Zip
			</label><br />
			<span class='mktInput'>
				<input class='mktFormText mktFormString mktFReq' name='PostalCode' id='PostalCode' size='23'  type='text' value=''  maxlength='255' tabIndex='8' />
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	public $submitButton = "<br /><input id='mktFrmSubmit' class='cta-button' type='button' style='margin-left:200px; width: 100px; overflow: visible; padding-left: .25em; padding-right: .25em; margin-top:60px; font-size:14px' name='submitButton' value='Submit' return false; />";
	public $form_type = 'test';
	public $followUpLevel;
	public $requestSubject;
	public $retURL;
	public $autoResponder;
	public $headerText;
	public $topContent;
	public $commentBox;
	public $primaryInterest;
	public $serviceLine;
	public $demo;
	public $pricing;
	public $emailSubscriptions;
	public $interest = "
		<span id='InterestSpan' class='uk-form-row'>
			<label class='uk-form-label'>
				Primary Interest
			</label><br />
			<span class='mktInput'>
			<select name='interest' class='requestinfo' size='1' style='padding: 2px !important; margin-bottom: 10px;'>
          <option value='Blood' selected='selected'>Blood</option>
          <option value='Cellular Therapy'>Cellular Therapy</option>
          <option value='Home Care'>Home Care</option>
          <option value='Med Management'>Medication Mgmt</option>
          <option value='Rehabilitation'>Rehabilitation</option>
          <option value='Respiratory'>Respiratory</option>
          <option value='SHG - Performance'>Performance Mgmt</option>
        </select>
				<span class='mktFormMsg'></span>
			</span><br />
		</span>
	";
	
	function SetAll($form_type, $followUpLevel, $requestSubject, $retURL, $autoResponder, $headerText, $topContent, 
					$commentBox, $primaryInterest, $serviceLine, $demo, $pricing, $emailSubscriptions, $interest){
		$this->form_type = $form_type;
		$this->followUpLevel = $followUpLevel;
		$this->requestSubject = $requestSubject;
		$this->retURL = $retURL;
		$this->autoResponder = $autoResponder;
		$this->headerText = $headerText;
		$this->topContent = $topContent;
		$this->commentBox = $commentBox;
		$this->interest = $interest;
		$this->primaryInterest = $primaryInterest;
		$this->serviceLine = $serviceLine;
		$this->demo = $demo;
		$this->pricing = $pricing;
		$this->emailSubscriptions = $emailSubscriptions;
	}

	function startForm(){ ?>
		<script src='http://ajax.googleapis.com/ajax/libs/jquery/1.7.2/jquery.min.js' type='text/javascript'></script>
		<script type='text/javascript' src='http://xxxxxxxx.com/js/formfunctions.js'></script>
		<form id='mktForm_1006' class='lpeRegForm formNotEmpty' action='http://app-o.marketo.com/index.php/leadCapture/save' method='post' name='mktForm_1006' enctype='application/x-www-form-urlencoded'>
				<script type='text/javascript'> function mktoGetForm() {return document.getElementById('mktForm_1006'); }</script>
	<?php } 
	function endForm(){ ?>
		<span style='display:none;'><input type='text' name='_marketo_comments' value='' /></span>
	  	<input type='hidden' name='lpId' value='1050' />
	  	<input type='hidden' name='subId' value='17' />
		<input type='hidden' name='kw' value='' />
		<input type='hidden' name='cr' value='' />
		<input type='hidden' name='searchstr' value='' />
		<input type='hidden' name='lpurl' value='http://na-o.marketo.com/lp/xxxxxx/GenericForm.html?cr={creative}&kw={keyword}' />
		<input type='hidden' name='formid' value='1006' />
		<input type='hidden' name='_mkt_disp' value='return' />
		<input type='hidden' name='_mkt_trk' value='id:596-FKF-634&token:_mch-marketo.com-1330369410817-92622' />
		<script type='text/javascript' src='http://na-o.marketo.com/js/mktFormSupport.js'></script>
		<script type='text/javascript'>
		function formSubmit(elt) {
			return Mkto.formSubmit(elt);
		}
		function formReset(elt) {
			return Mkto.formReset(elt);
		}
		</script>
		</form>
	<?php }
	function hiddenFields(){
	$requestSubject = $this->requestSubject;
	$serviceLine = $this->serviceLine;
        $interest = (isset($_POST['interest']) && $_POST['interest'] != '') ? $_POST['interest'] : $serviceLine;
	$followUpLevel = $this->followUpLevel;
	$retURL = $this->retURL;
	$autoResponder = $this->autoResponder;
	?>
		<input name='Request_Name' id='Request_Name' class='requestinfo' type='hidden' value="<?php echo $requestSubject; ?>"  maxlength='255'/>
		<input name='Request_Type' id='Request_Type' class='requestinfo' type='hidden' value='Web'  maxlength='255'/>
		<input name='Primary_Interest' id='Primary_Interest' class='requestinfo' type='hidden' value="<?php echo $interest; ?>"  maxlength='255'/>
		<input name='Follow_Up_Level' id='Follow_Up_Level' class='requestinfo' type='hidden' value="<?php echo $followUpLevel; ?>" maxlength='255'/>
		<input name='Hide_Request_Info__c' id='Hide_Request_Info__c' maxlength='1500' type='hidden'>
		<input name='Hide_Cookie_Info__c' id='Hide_Cookie_Info__c' maxlength='1500' type='hidden'>
		<input name='Hide_Form_Comments__c' id='Hide_Form_Comments__c' class='' maxlength='1500' type='hidden'>
		<input type='hidden' id='returnURL' name='returnURL' value="<?php echo $retURL; ?>"/>
		<input type='hidden' id='retURL' name='retURL' value="<?php echo $retURL; ?>" />
		<input name='Auto_Responder__c' id='Auto_Responder__c' type='hidden' value="<?php echo $autoResponder;?>" />
	<?php } 					
}
?>


<?php  
	function mortyForm(){
		/* set the connection and login credentials to MYSQL */
		$con = mysql_connect("localhost","user","password");
		if (!$con){
			die('Could not connect: ' . mysql_error());
		}
		
		/* Connect to to MYSQL database */	
		mysql_select_db("database_table", $con);
		
		/* set the slug variable that will select the row from the database (the if statemenet handles if there are extra params in the url) */
		$slug2 = 'http://www.'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"];
		$slug = 'http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"];
		if(strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '/?') || strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?')){
			$slug = substr('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], 0, strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?'));
			$slug2 = substr('http://www.'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], 0, strpos('http://'.$_SERVER["SERVER_NAME"].$_SERVER["REQUEST_URI"], '?'));
		}
	 	
	 	
		/* set the query to return matching rows */
		$result = mysql_query("SELECT * FROM uber_forms WHERE page_url = '".$slug."' or page_url = '".$slug2."'");
		
		while ($row = mysql_fetch_array($result)){
			$form_type = $row['form_type'];
			$followUpLevel = $row['followup_level'];
			$requestSubject = $row['request_subject'];
			$retURL = $row['returl'];
			$autoResponder = $row['autoresponder'];
			$headerText = $row['header'];
			$primaryInterest = $row['primary_interest'];
			$serviceLine = $row['service_line'];
			$emailSubscriptions = $row['email_subscription'];
			if($row['demo'] == 1 && $row['pricing'] == 1){
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo chk' type='checkbox' value='false' />I want to schedule a demo<br />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo chk' type='checkbox' value='false' />I want information on pricing<br />";
			}
			else if($row['pricing'] == 1){
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo' type='hidden' value='true' />";
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo' type='hidden' value='false' />";
			}
			else if($row['demo'] == 1){
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo' type='hidden' value='true' />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo' type='hidden' value='false' />";
			}
			else{
				$demo = "<input name='Demo_Request' id='Demo_Request' class='requestinfo chk' type='hidden' value='false' />";
				$pricing = "<input name='Pricing_Request' id='Pricing_Request' class='requestinfo chk' type='hidden' value='false' />";
			}
			
			$commentBox = "<label>".$row['comment_box']."</label>";
			
			if($row['top_content'] != NULL){
				$topContent = "<div class='top-content'>".$row['top_content']."</div>";
			}
			
			/* if the comment_box column has any characters in it at all (including blanks) set the commentbox var to the textarea */
			if($row['comment_box'] != NULL){
				$commentBox .= "<textarea class='mktFormText mktFormString formcomments' id='Comment_Question__c' name='Comment_Question__c'></textarea>";
			}
			else{
				$commentBox = NULL;
			}
			
		}
		$form = new Form;
		$form->SetAll($form_type, $followUpLevel, $requestSubject, $retURL, $autoResponder, $headerText, $topContent, $commentBox, $primaryInterest, $serviceLine, $demo, $pricing, $emailSubscriptions, $interest);
		getFormType($form);
		mysql_close($con);
	}
?>
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https://forums.phpfreaks.com/topic/284460-form-problems/#findComment-1461140
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