Code: Select all
<?
function generateEmail($realname, $Address, $City, $State, $Zip, $County, $email, $DayPhone, $NightPhone, $smoker, $InsCompanyName, $PolicyExpMonth, $PolicyExpDay, $PolicyExpYear, $AmountInsuredFor, $deductable, $personalumbrella, $liabilitylimit, $area, $SqFootOfHome, $HomeBuiltYear, $hydrants, $HomeType, $Construction, $Roof, $RoofAge, $Foundation, $GarageSize, $GarageType, $BathroomsFull, $BathroomsHalf, $Basement, $BasementSqFt, $DeckSqFt, $PorchSqFt, $ScreenedSqFt, $Chimneys, $Hearths, $HeatingSystem, $CentralAir, $CentralVac, $SecurityAlarm, $FireAlarm, $SmokeDetector, $fireextinguishers, $deadboltlocks, $jewerlry, $jewelryamount, $silverware, $silverwareamount, $furs, $fursamount, $other, $otheramount, $losses, $lossvalue, $mortgage, $escrowed, $buseexp)
{
return "
<html>
<div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>General
Information</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Name:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$realname</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Address:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$Address</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">City:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$City <b>State:</b> $State
<b>ZIP:</b> $Zip</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">County:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\"$County <b>Email:</b> $email</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Phone Day:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$DayPhone <b>Night:</b> $NightPhone</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Smoker:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\">$smoker</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Current
Homeowners Insurance Company <i>(not agency)</i>:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Company Name:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$InsCompanyName</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Policy Exp. Date:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$PolicyExpMonth / $PolicyExpDay / $PolicyExpYear</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Amount Insured For:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$ $AmountInsuredFor</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Deductable:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$ $deductable</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Personal Umbrella:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$ $personalumbrella</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Liability Limit:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$ $liabilitylimit</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Contents:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\"> $area</font></td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Home
Information</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\"><b>Sq. footage of home</b> (excluding<br>
garage and basement):</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">$SqFootOfHome</font></td>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><b><font SIZE=\"-1\">Year home was built:</font></b></td>
<td ALIGN=\"LEFT\" VALIGN=\"BOTTOM\"><font SOIZE=\"-1\">$HomeBuiltYear</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Fire hydrants on street:</td>
<TD ALIGN=\"left\" VALIGN=\"top\" COLSPAN=\"1\" ROWSPAN=\"1\">$hydrant</TD>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Structure
Information</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><table BORDER=\"2\" CELLSPACING=\"0\">
<tr>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Type:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Construction:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Roof:</font></b></td>
<td ALIGN=\"CENTER\" \"><b><font SIZE=\"-1\">Foundation:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Garage:</font></b></td>
</tr>
<tr>
<td ALIGN=\"CENTER\">$HomeType
</select></td>
<td ALIGN=\"CENTER\">$Construction</td>
<td ALIGN=\"CENTER\">$Roof</td>
<td ALIGN=\"CENTER\">$Foundation</td>
<td ALIGN=\"CENTER\">$GarageSize</td>
</tr>
<tr>
<td COLSPAN=\"2\"> </td>
<td ALIGN=\"LEFT\"><font SIZE=\"-1\">Age of roof: $RoofAge yrs.</font></td>
<td> </td>
<td ALIGN=\"CENTER\">$GarageType</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Features</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><table BORDER=\"2\" CELLSPACING=\"0\">
<tr>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Bathrooms:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Basement:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Deck/Porch/Patio:</font></b></td>
<td ALIGN=\"CENTER\" \"><b><font SIZE=\"-1\">Fireplaces:</font></b></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"TOP\"><font SIZE=\"-1\"> # of Full: $BathroomsFull <br>
# of Half: $BathroomsHalf </font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$Basement<br>
Sq. Ft: $BasementSqFt</font></td>
<td ALIGN=\"RIGHT\" VALIGN=\"TOP\"><font SIZE=\"-1\">Deck Sq. Ft: $DeckSqFt <br>
Porch Sq. Ft: $PorchSqFt <br>
Screened Patio Sq. Ft: $ScreenSqFt
</font></td>
<td ALIGN=\"RIGHT\" VALIGN=\"TOP\"><font SIZE=\"-1\"> # of Chimneys: $Chimneys <br>
# of Hearths: $Hearths </font></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Additional
Features</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><table BORDER=\"2\" CELLSPACING=\"0\">
<tr>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Heating System:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Central Air:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Central Vac:</font></b></td>
<td ALIGN=\"CENTER\"><b><font SIZE=\"-1\">Security Alarm:</font></b></td>
<td ALIGN=\"CENTER\" \"><b><font SIZE=\"-1\">Fire Alarm:</font></b></td>
<td ALIGN=\"CENTER\" \"><b><font SIZE=\"-1\">Smoke Detector:</font></b></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$HeatingSystem</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$CentralAir</td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$CentralVac</td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$SecurityAlarm</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$FireAlarm</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">$SmokeDetector</td>
</tr>
<TR>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">Fire Extinguishers:</font><BR>
$fireextinguishers</td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\"><font SIZE=\"-1\">Dead Bolt Locks:</font><BR>
$deadboltlocks</td>
</TR>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Additional
Features</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><table BORDER=\"2\" CELLSPACING=\"0\">
Schedule:
<TR>
<TD>
$jewerlry Jewelry $$jewelryamount<BR>
$Silverware Silverware $$silverwareamount<BR>
$furs Furs $$fursamount<BR>
$Other Other $$otheramount<BR>
</TD>
<TD>
Losses in the past 3 years:<BR>
$losses Value: $lossvalue
</TD>
</TR>
<TR>
<TD>
Mortgage: $mortgage Escrowed:$escrowed
</TD>
<TD>
Is there any business exposure on premesis?<BR>
$buseexp
</TD>
</TR>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Additional
Comments:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><table BORDER=\"2\" CELLSPACING=\"0\">
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">Please give any additional comments about the coverage
you desire:<br>
$comments</font></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div>
";
}
// ..........
mail("nickman013@mac.com",
"Regional Planning Home Quote Submission Form",generateEmail($realname, $Address, $City, $State, $Zip, $County, $email, $DayPhone, $NightPhone, $smoker, $InsCompanyName, $PolicyExpMonth, $PolicyExpDay, $PolicyExpYear, $AmountInsuredFor, $deductable, $personalumbrella, $liabilitylimit, $area, $SqFootOfHome, $HomeBuiltYear, $hydrants, $HomeType, $Construction, $Roof, $RoofAge, $Foundation, $GarageSize, $GarageType, $BathroomsFull, $BathroomsHalf, $Basement, $BasementSqFt, $DeckSqFt, $PorchSqFt, $ScreenedSqFt, $Chimneys, $Hearths, $HeatingSystem, $CentralAir, $CentralVac, $SecurityAlarm, $FireAlarm, $SmokeDetector, $fireextinguishers, $deadboltlocks, $jewerlry, $jewelryamount, $silverware, $silverwareamount, $furs, $fursamount, $other, $otheramount, $losses, $lossvalue, $mortgage, $escrowed, $buseexp),
"Content-type: text/html\r\n");
?>