Help with PHP Mail Script
Posted: Mon Aug 15, 2005 6:17 pm
Hello,
I have a mail script that works with other inputs, this script sends the information to my email address with HTML in it, however the problem is I get a parse error on line 1.
Line 1 is <? .
My server is running php3. I know, I know, it is old but I havnt had time to switch over to the new server. Well the code is below.
I have a mail script that works with other inputs, this script sends the information to my email address with HTML in it, however the problem is I get a parse error on line 1.
Line 1 is <? .
My server is running php3. I know, I know, it is old but I havnt had time to switch over to the new server. Well the code is below.
Code: Select all
<?
function generateEmail($realname, $Address, $City, $State, $Zip, $County, $ResidentOf, $EnterTownship, $email, $DayPhone, $NightPhone, $CurrentInsuranceCo, $PolicyExpMonth, $PolicyExpDay, $PolicyExpYear, $Car1Make, $Car1Model, $Car1SubModel, $Car1NumOfDoors, $Car1VIN, $Car1DrivenToWork, $Car1ABS, $Car1AntiTheft, $Car2Make, $Car2Model, $Car2SubModel, $Car2NumOfDoors, $Car2VIN, $Car2DrivenToWork, $Car2ABS, $Car2AntiTheft, $Car3Make, $Car3Model, $Car3SubModel, $Car3NumOfDoors, $Car3VIN, $Car1DrivenToWork, $Car3ABS, $Car3AntiTheft, $bodily_coverage, $property_coverage, $medical_coverage, $unins_coverage,$comprehensive_coverage, $colleduct_coverage, $towing_coverage, $rental_coverage, $leaseloangap_coverage, $Driver1Name, $Driver1Occupation, $Driver1Relation, $Driver1BirthMonth, $Driver1BirthDay, $Driver1BirthYear,$Driver1Gender, $Driver1Status, $Driver1DriversEd, $Driver1GoodStudent, $Driver1DrivesVeh, $Driver2Name, $Driver2Occupation, $Driver2Relation, $Driver2BirthMonth, $Driver2BirthDay, $Driver2BirthYear,$Driver2Gender, $Driver2Status, $Driver2DriversEd, $Driver2GoodStudent, $Driver2DrivesVeh, $Driver2Name, $Driver3Name, $Driver3Occupation, $Driver3Relation, $Driver3BirthMonth, $Driver3BirthDay, $Driver3BirthYear,$Driver3Gender, $Driver3Status, $Driver3DriversEd, $Driver3GoodStudent, $Driver3DrivesVeh, $Driver3Name, $Driver1ConvictedName, $Driver1ConvictedMonth, $Driver1ConvictedDay, $Driver1ConvictedYear, $Driver1TypeConviction, $Driver1ConvictionMPH, $Driver2ConvictedName, $Driver2ConvictedMonth, $Driver2ConvictedDay, $Driver2ConvictedYear, $Driver2TypeConviction, $Driver2ConvictionMPH, $Driver3ConvictedName, $Driver3ConvictedMonth, $Driver3ConvictedDay, $Driver3ConvictedYear, $Driver3TypeConviction, $Driver3ConvictionMPH, $Driver4ConvictedName, $Driver4ConvictedMonth, $Driver4ConvictedDay, $Driver4ConvictedYear, $Driver4TypeConviction, $Driver4ConvictionMPH, $AccidentsPast5Years, $Driver1AccidentName, $Driver1AccidentMonth, $Driver1AccidentDay, $Driver1AccidentYear, $Driver1AccidentCost, $Driver1AccidentFines, $Driver1AccidentInjuries, $Driver1AccidentFaultFree, $Driver1AccidentDescription, $Driver2AccidentName, $Driver2AccidentMonth, $Driver2AccidentDay, $Driver2AccidentYear, $Driver2AccidentCost, $Driver2AccidentFines, $Driver2AccidentInjuries, $Driver2AccidentFaultFree, $Driver2AccidentDescription, $Driver3AccidentName, $Driver3AccidentMonth, $Driver3AccidentDay, $Driver3AccidentYear, $Driver3AccidentCost, $Driver3AccidentFines, $Driver3AccidentInjuries, $Driver3AccidentFaultFree, $Driver3AccidentDescription, $Driver4AccidentName, $Driver4AccidentMonth, $Driver4AccidentDay, $Driver4AccidentYear, $Driver4AccidentCost, $Driver4AccidentFines, $Driver4AccidentInjuries, $Driver4AccidentFaultFree, $Driver4AccidentDescription, $comments)
{
return "
<div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"center\" VALIGN=\"TOP\"><font COLOR=\"#000000\"><b>General Information</b></font></td>
</tr>
<tr>
<td ALIGN=\"center\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Name:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$realname</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Address:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$Address</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">City:</
font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$City\" VALUE SIZE=\"26\"
MAXLENGTH=\"30\"> State: $State
ZIP: $Zip<font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">County:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$County </font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Resident of</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\">$ResidentOf If Townshipenter name:</small></small>$EnterTownship</td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Email</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$emai</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Phone Day:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$DayPhone Night: $NightPhone</font></td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Current Auto
Insurance Company <i>(not agency)</i>:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\"><font SIZE=\"-1\">Company Name:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$CurrentInsuranceCo</font></td>
</tr>
<tr>
<td ALIGN=\"RIGHT\" VALIGN=\"BOTTOM\">
<font SIZE=\"-1\">Policy Exp. Date:</font></td>
<td ALIGN=\"LEFT\" VALIGN=\"TOP\"><font SIZE=\"-1\">$PolicyExpMonth / $PolicyExpDay / $PolicyExpYear (mm/dd/yyyy)</font></td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Vehicle
Inform
ation:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><i><font SIZE=\"-1\">(include all cars you or your family members own or
lease) <table BORDER=\"2\" CELLSPACING=\"0\" width=\"721\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"CENTER\" ROWSPAN=\"2\" BGCOLOR=\"#aaaaaa\" width=\"33\"><h2></font></i><small><font
COLOR=\"#000000\"><b>Car #1</b></font></small><font SIZE=\"-1\"><i></h2>
</i></font></td>
<td ALIGN=\"CENTER\" width=\"44\"><font SIZE=\"-1\">Year</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Make</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Model</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Su
b Model</font></td>
<td ALIGN=\"CENTER\" width=\"80\">Number of Doors</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Vehicle ID# (VIN)</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"44\">$Car1Year</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car1Make</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car1Model</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car1SubModel</td>
<td ALIGN=\"center\" width=\"80\">$Car1NumOfDoors\"></td>
<td ALIGN=\"CENTER\" width=\"188\">$Car1VIN</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" COLSPAN=\"6\" width=\"525\"><font size=\"2\">Drive to school, work, station?</font><font
size=\"1\"> </font>$Car1DrivenToWork<br>
# of miles (one way):</font> $Car1MilesOneWay
</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Car equipped w/ ABS?<br>
$Car1ABS<br>
Anti-theft devices?<br>
$Car1AntiTheft</font></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Vehicle
Information:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><i><font SIZE=\"-1\">(include all cars you or your family members own or
lease) <table BORDER=\"2\" CELLSPACING=\"0\" width=\"716\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"CENTER\" ROWSPAN=\"2\" BGCOLOR=\"#aaaaaa\" width=\"33\"><h2></font></i><small><font
COLOR=\"#000000\"><b>Car #2</b></font></small><font SIZE=\"-1\"><i></h2>
</i></font></td>
<td ALIGN=\"CENTER\" width=\"44\"><font SIZE=\"-1\">Year</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Make</font></td>
<td ALIGN=\"CENTER\" width=\"116\
"><font SIZE=\"-1\">Model</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Sub Model</font></td>
<td ALIGN=\"center\" width=\"75\">Number of Doors</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Vehicle ID# (VIN)</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"44\">$Car2Year</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car2Make</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car2Model</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car2SubModel</td>
<td ALIGN=\"center\" width=\"75\"> $Car2NumOfDoors</td>
<td ALIGN=\"CENTER\" width=\"188\">$Car2VIN</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" COLSPAN=\"6\" width=\"520\"><font size=\"2\">Drive to school, work, station?</font><font
size=\"1\"> </font>$Car2DrivenToWork
<font size=\"2\"><br>
# of miles (one way):</font> $Car2MilesOneWay
</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Car equipped w/ ABS?<br>
$Car2ABS<br>
Anti-theft devices?<br>
$Car2AntiTheft </font></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Vehicle
Information:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><i><font SIZE=\"-1\">(include all cars you or your family members own or
lease) <table BORDER=\"2\" CELLSPACING=\"0\" width=\"713\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"CENTER\" ROWSPAN=\"2\" BGCOLOR=\"#aaaaaa\" width=\"33\"><h2></font></i><small><font
COLOR=\"#000000\"><b>Car #3</b></font></small><font SIZE=\"-1\"><i></h2>
</i></font></td>
<td ALIGN=\"CENTER\" width=\"44\"><font SIZE=\"-1\">Year</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Make</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Model</font></td>
<td ALIGN=\"CENTER\" width=\"116\"><font SIZE=\"-1\">Sub Model</font></td>
<td ALIGN=\"center\" width=\"72\">Number of Doors</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Vehicle ID# (VIN)</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"44\">$Car3Year</td>
<td ALIGN=\"CENTER\" wi
dth=\"116\">$Car3Make</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car3Model</td>
<td ALIGN=\"CENTER\" width=\"116\">$Car3SubModel</td>
<td ALIGN=\"center\" width=\"72\">$Car3NumOfDoors</td>
<td ALIGN=\"CENTER\" width=\"188\">$Car3VIN</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" COLSPAN=\"6\" width=\"517\"><font size=\"2\">Drive to school, work, station?</font><font
size=\"1\"> </font>$Car3DrivenToWork <br>
<font size=\"2\"><br>
# of miles (one way):</font> $Car3MilesOneWay
</td>
<td ALIGN=\"CENTER\" width=\"188\"><font SIZE=\"-1\">Car equipped w/ ABS?<br>
$Car3ABS<br>
Anti-theft devices?<br>
$Car3AntiTheft</font></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Coverages:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<TD>
Bodily Injury:$bodily_coverage <BR>
Property Damage:$property_coverage<BR>
Medical Payments:$medical_coverage<BR>
Uninsured Motorist:$unins_coverage<BR>
Comprehensive Damage:$comprehensive_coverage<BR>
Collision Dedcutable:$colldeduct_coverage<BR>
Towing:$towing_coverage<BR>
Rental Reimbursement:$rental_coverage<BR>
Lease/Loan Gap:$leaseloangap_coverage<BR>
</TD>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div al
ign=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Driver
Information:</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\"><i>(including all licensed drivers in your household
)</i>
<table BORDER=\"2\" CELLSPACING=\"0\" height=\"278\">
<tr>
<td ALIGN=\"center\" VALIGN=\"middle\" ROWSPAN=\"2\" height=\"82\"><font SIZE=\"-1\">Driver's Name</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"middle\" ROWSPAN=\"2\" width=\"116\" height=\"82\"><font SIZE=\"-1\">Occupation</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"middle\" ROWSPAN=\"2\" width=\"84\" height=\"82\"><font SIZE=\"-1\">Relation<br>
to you</font></td>
<td ALIGN=\"center\" VALIGN=\"middle\" ROWSPAN=\"2\" height=\"82\"><font SIZE=\"-1\">Date of birth<br>
(MM/DD/YYYY)</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" ROWSPAN=\"2\" width=\"43\" height=\"82\"><font SIZE=\"-2\">Male/<br>
Female<p>M / F</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" ROWSPAN=\"2\" width=\"44\" height=\"82\"><font SIZE=\"-2\">Married/<br>
Single
<p>M / S</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" COLSPAN=\"2\" width=\"84\" height=\"43\"><font SIZE=\"-1\">Completed</font></td>
<td ALIGN=\"CENTER\" VALIGN=\"TOP\" COLSPAN=\"3\" width=\"144\" height=\"43\"><font SIZE=\"-1\">Which
Vehicle is Driver primary operator of?<br>
(Please check)</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"46\" height=\"43\">Drivers<br
>
Education<br>
Course</font><font SIZE=\"-2\">?</font></td>
<td ALIGN=\"CENTER\" width=\"34\" height=\"43\"><font SIZE=\"-2\">Student GPA 3.0 or better?</font></td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\"><font SIZE=\"-1\">#1</font></td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\"><font SIZE=\"-1\">#2</font></td>
<td ALIGN=\"CENTER\" width=\"41\" height=\"43\"><font SIZE=\"-1\">#3</font></td>
</tr>
<tr>
<td ALIGN=\"center\" height=\"43\">$Driver1Name</td>
<td ALIGN=\"CENTER\" width=\"116\" height=\"43\">$Driver1Occupation</td>
<td ALIGN=\"CENTER\" width=\"84\" height=\"43\">$Driver1Relationship</td>
<td ALIGN=\"center\" height=\"43\">$Driver1BirthMonth /$Driver1BirthDay /$Driver1BirthYear</td>
<td ALIGN=\"CENTER\" width=\"43\" height=\"43\">$Driver1Gende
r</td>
<td ALIGN=\"CENTER\" width=\"44\" height=\"43\">$Driver1Status</td>
<td ALIGN=\"CENTER\" width=\"46\" height=\"43\">$Driver1DriversEd</td>
<td ALIGN=\"CENTER\" width=\"34\" height=\"43\"><font SIZE=\"-1\">$Driver1GoodStudent</td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\">$Driver1DrivesVeh</td>
</tr>
<tr>
<td ALIGN=\"center\" height=\"43\">$Driver2Name</td>
<td ALIGN=\"CENTER\" width=\"116\" height=\"43\">$Driver2Occupation</td>
<td ALIGN=\"CENTER\" width=\"84\" height=\"43\">$Driver2Relationship</td>
<td ALIGN=\"center\" height=\"43\">$Driver2BirthMonth / $Driver2BirthDay / $Driver2BirthYear</td>
<td ALIGN=\"CENTER\" width=\"43\" height=\"43\"><font SIZE=\"-1\">$Driver2Gender</td>
<td ALIGN=\"CENTER\" width=\"44\" height=\"43\"><font SIZE=\"-1\">$Driver2Status</td>
<td ALIGN=\"CENTER\" width=\"46\" height=\"43\"><font SIZE=\"-1\">$Driver2DriversEd</td>
<td ALIGN=\"CENTER\" width=\"34\" height=\"43\"><font SIZE=\"-1\">$Driver2GoodStudent</td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\"$Driver2DrivesVeh</td>
</tr>
<tr>
<td ALIGN=\"center\" height=\"43\"$Driver3Name</td>
<td ALIGN=\"CENTER\" width=\"116\" height=\"43\">$Driver3Occupation</td>
<td ALIGN=\"CENTER\" width=\"84\" height=\"43\">$Driver3Relationship</td>
<td ALIGN=\"center\" height=\"43\">$Driver3BirthMonth /$Driver3BirthDay /$Driver3BirthYear </td>
<td ALIGN=\"CENTER\" width=\"43\" height=\"43\"><font SIZE=\"-1\">$Driver3Gender</td>
<td ALIGN=\"CENTER\" width=\"44\" height=\"43\"><font SIZE=\"-1\">$Driver3Status</td>
<td ALIGN=\"CENTER\" width=\"46\" height=\"43\"><font SIZE=\"-1\">$Driver3DriversEd</td>
<td ALIGN=\"CENTER\" width=\"34\" height=\"43\"><font SIZE=\"-1\">$Driver3GoodStudent</td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\">$Driver3DrivesVeh</td>
</tr>
<tr>
<td ALIGN=\"center\" height=\"43\">$Driver4Name</td>
<td ALIGN=\"CENTER\" width=\"116\" height=\"43\">$Driver4Occupation</td>
<td ALIGN=\"CENTER\" width=\"84\" height=\"43\">$Driver4Relationship</td>
<td ALIGN=\"center\" height=\"43\">$Driver4BirthMonth / $Driver4BirthDay /$Driver4BirthYear</td>
<td ALIGN=\"CENTER\" width=\"43\" height=\"43\"><font SIZE=\"-1\">$Driver4Gender</td>
<td ALIGN=\"CENTER\" width=\"44\" height=\"43\"><font SIZE=\"-1\">$Driver4Status</td>
<td ALIGN=\"CENTER\" width=\"46\" height=\"43\"><font SIZE=\"-1\">$Driver4DriversEd</td>
<td ALIGN=\"CENTER\" width=\"34\" height=\"43\"><font SIZE=\"-
1\">$Driver4GoodStudent</td>
<td ALIGN=\"CENTER\" width=\"40\" height=\"43\">$Driver4DrivesVeh</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</center></div><div align=\"center\"><center><table WIDTH=\"600\" BORDER=\"2\">
<tr>
<td ALIGN=\"CENTER\" BGCOLOR=\"#aaaaaa\"><font COLOR=\"#000000\"><b>Driver History</b></font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><table WIDTH=\"590\" BGCOLOR=\"#dddddd\" CELLPADDING=\"2\" CELLSPACING=\"0\"
BORDER=\"0\">
<tr>
<td ALIGN=\"CENTER\"><b>If you answer "yes" to any of the following questions
below,<br>
please explain in the space provided: <p>Has any driver listed:</b> </p>
<div align=\"center\"><center><p><b>1.</b> Been convicted of any moving traffic violation in
the past 3 years?<br>
$BeenConvicted3Years <br>
If yes, please answer the following: <br>
</p>
</center></div><div align=\"center\"><center><table BORDER=\"2\" CELLSPACING=\"0\">
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">Driver</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">Date</font></td>
<td ALIGN=\"CENTER\"><f
ont SIZE=\"-1\">Type of Conviction</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">Speed<br>
Over Limit</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver1ConvictedName\" VALUE SIZE=\"15\"
MAXLENGTH=\"40\"></font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver1ConvictedMonth /$Driver1ConvictedDay / $Driver1ConvictedYear</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver1TypeConviction</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-2\">$Driver1ConvictionMPH MPH</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver2ConvictedName</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver2ConvictedMonth /$Driver2ConvictedDay /$Driver2ConvictedYear</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Dri
ver2TypeConviction</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-2\"$Driver2ConvictionMPH MPH</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver3Convi
ctedName</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver3ConvictedMonth /$Driver3ConvictedDay /$Driver3ConvictedYear</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver3TypeConviction</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-2\">$Driver3ConvictionMPH MPH</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver4ConvictedName</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver4ConvictedMonth /$Driver4ConvictedDay /$Driver4ConvictedYear</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-1\">$Driver4TypeConviction</font></td>
<td ALIGN=\"CENTER\"><font SIZE=\"-2\">$Driver4ConvictionMPH MPH</font></td>
</tr>
</table>
</center></div><div align=\"center\"><center><p><b>2.</b> Been involved in any accidents,
regardless of fault, in the past 5 years?<br>
$AccidentPast5Years<br>
If yes, please answer the following: <br>
</p>
</center></div><div align=\"center\"><center><table BORDER=\"2\" CELLSPACING=\"0\" width=\"602\">
<tr>
<td ALIGN=\"CENTER\" width=\"99\"><font SIZE=\"-1\">Driver</font></td>
<td ALIGN=\"center\" width=\"123\"><font SIZE=\"-1\">Date</font></td>
<td ALIGN=\"CENTER\" width=\"63\"><font SIZE=\"-1\">Cost</font></td>
<td ALIGN=\"CENTER\" width=\"72\"><font SIZE=\"-1\">Fines</font></td>
<td ALIGN=\"CENTER\" width=\"39\"><font SIZE=\"-1\">Injuries?</font></td>
<td ALIGN=\"CENTER\" width=\"49\"><font SIZE=\"-1\">Fault Free?</font></td>
<td ALIGN=\"CENTER\" width=\"129\"><font SIZE=\"-1\">Description</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"99\"><font SIZE=\"-1\">$Driver1AccidentName</font></td>
<td ALIGN=\"center\" width=\"123\"><font SIZE=\"-1\">$Driver1AccidentMonth /$Driver1AccidentDay /$Driver1AccidentYear</font></td>
<td ALIGN=\"CENTER\" width=\"63\"><font S
IZE=\"-1\">$Driver1AccidentCost</font></td>
<td ALIGN=\"CENTER\" width=\"72\"><font SIZE=\"-1\">$Driver1AccidentFines</font></td>
<td ALIGN=\"CENTER\" width=\"39\"><font SIZE=\"-1\">$Driver1AccidentInjuries</font></td>
<td ALIGN=\"CENTER\" width=\"49\"><font SIZE=\"-1\">$Driver1AccidentFaultFree</font></td>
<td ALIGN=\"CENTER\" width=\"129\"><font SIZE=\"-2\">$Driver1AccidentDescription</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"99\"><font SIZE=\"-1\">$Driver2AccidentName</font></td>
<td ALIGN=\"center\" width=\"123\"><font SIZE=\"-1\">$Driver2AccidentMonth /$Driver2AccidentDay /$Driver2AccidentYear</font></td>
<td ALIGN=\"CENTER\" width=\"63\"><font SIZE=\"-1\">$Driver2AccidentCost</font></td>
<td ALIGN=\"CENTER\" width=\"72\"><font SIZE=\"-1\">$Driver2AccidentFines</font></td>
<td ALIGN=\"CENTER\" wid
th=\"39\"><font SIZE=\"-1\">$Driver2AccidentInjuries</font></td>
<td ALIGN=\"CENTER\" width=\"49\"><font SIZE=\"-1\">$Driver2AccidentFaultFree</font></td>
<td ALIGN=\"CENTER\" width=\"129\"><font SIZE=\"-2\">$Driver2AccidentDescription</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"99\"><font SIZE=\"-1\">$Driver3AccidentName</font></td>
<td ALIGN=\"center\" width=\"123\"><font SIZE=\"-1\">$Driver3AccidentMonth /$Driver3AccidentDay /$Driver3AccidentYear</font></td>
<td ALIGN=\"CENTER\" width=\"63\"><font SIZE=\"-1\">$Driver3AccidentCost</font></td>
<td ALIGN=\"CENTER\" width=\"72\"><font SIZE=\"-1\">$Driver3AccidentFines</font></td>
<td ALIGN=\"CENTER\" width=\"39\"><font SIZE=\"-1\">$Driver3AccidentInjuries</font></td>
<td ALIGN=\"CENTER\" width=\"49\"><font SIZE=\"-1\">$Driver3AccidentFaultFree</font></td>
<td ALIGN=\"CENTER\" width=\"129\"><font SIZE=\"-2\">$Driver3AccidentDescription</font></td>
</tr>
<tr>
<td ALIGN=\"CENTER\" width=\"99\"><font SIZE=\"-1\">$Driver4AccidentName</font></td>
<td ALIGN=\"center\" width=\"123\"><font SIZE=\"-1\">$Driver4AccidentMonth /$Driver4AccidentDay /$Driver4AccidentYear</font></td>
<td ALIGN=\"CENTER\" width=\"63\"><font SIZE=\"-1\">$Driver4AccidentCost</font></td>
<td ALIGN=\"CENTER\" width=\"72\"><font SIZE=\"-1\">$Driver4AccidentFines</font></td>
<td ALIGN=\"CENTER\" width=\"39\"><font SIZE=\"-1\">$Driver4AccidentInjuries</font></td>
<td ALIGN=\"CENTER\" width=\"49\"><font SIZE=\"-1\">$Driver4AccidentFaultFree</font></td>
<td ALIGN=\"CENTER\" width=\"129\"><font SIZE=\"-2\">$Driver4AccidentDescription</font></td>
</tr>
</table>
</center></div></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, $ResidentOf, $EnterTownship, $email, $DayPhone, $NightPhone, $CurrentInsuranceCo, $PolicyExpMonth, $PolicyExpDay, $PolicyExpYear, $Car1Make, $Car1Model, $Car1SubModel, $Car1NumOfDoors, $Car1VIN, $Car1DrivenToWork, $Car1ABS, $Car1AntiTheft, $Car2Make, $Car2Model, $Car2SubModel, $Car2NumOfDoors, $Car2VIN, $Car2DrivenToWork, $Car2ABS, $Car2AntiTheft, $Car3Make, $Car3Model, $Car3SubModel, $Car3NumOfDoors, $Car3VIN, $Car1DrivenToWork, $Car3ABS, $Car3AntiTheft, $bodily_coverage, $property_coverage, $medical_coverage, $unins_coverage,$comprehensive_coverage, $colleduct_coverage, $towing_coverage, $rental_coverage, $leaseloangap_coverage, $Driver1Name, $Driver1Occupation, $Driver1Relation, $Driver1BirthMonth, $Driver1BirthDay, $Driver1BirthYear,$Driver1Gender, $Driver1Status, $Driver1DriversEd, $Driver1GoodStudent, $Driver1DrivesVeh, $Driver2Name, $Driver2Occupation, $Driver2Relation, $Driver2BirthMonth, $Driver2BirthDay, $Driver2BirthYear,$Driver2Gender, $Driver2Status, $Driver2DriversEd, $Driver2GoodStudent, $Driver2DrivesVeh, $Driver2Name, $Driver3Name, $Driver3Occupation, $Driver3Relation, $Driver3BirthMonth, $Driver3BirthDay, $Driver3BirthYear,$Driver3Gender, $Driver3Status, $Driver3DriversEd, $Driver3GoodStudent, $Driver3DrivesVeh, $Driver3Name, $Driver1ConvictedName, $Driver1ConvictedMonth, $Driver1ConvictedDay, $Driver1ConvictedYear, $Driver1TypeConviction, $Driver1Convicti
onMPH, $Driver2ConvictedName, $Driver2ConvictedMonth, $Driver2ConvictedDay, $Driver2ConvictedYear, $Driver2TypeConviction, $Driver2ConvictionMPH, $Driver3ConvictedName, $Driver3ConvictedMonth, $Driver3ConvictedDay, $Driver3ConvictedYear, $Driver3TypeConviction, $Driver3ConvictionMPH, $Driver4ConvictedName, $Driver4ConvictedMonth, $Driver4ConvictedDay, $Driver4ConvictedYear, $Driver4TypeConviction, $Driver4ConvictionMPH, $AccidentsPast5Years, $Driver1AccidentName, $Driver1AccidentMonth, $Driver1AccidentDay, $Driver1AccidentYear, $Driver1AccidentCost, $Driver1AccidentFines, $Driver1AccidentInjuries, $Driver1AccidentFaultFree, $Driver1AccidentDescription, $Driver2AccidentName, $Driver2AccidentMonth, $Driver2AccidentDay, $Driver2AccidentYear, $Driver2AccidentCost, $Driver2AccidentFines, $Driver2AccidentInjuries, $Driver2AccidentFaultFree, $Driver2AccidentDescription, $Driver3AccidentName, $Driver3AccidentMonth, $Driver3AccidentDay, $Driver3AccidentYear, $Driver3AccidentCost, $Driver3AccidentFines, $Driver3AccidentInjuries, $Driver3AccidentFaultFree, $Driver3AccidentDescription, $Driver4AccidentName, $Driver4AccidentMonth, $Driver4AccidentDay, $Driver4AccidentYear, $Driver4AccidentCost, $Driver4AccidentFines, $Driver4AccidentInjuries, $Driver4AccidentFaultFree, $Driver4AccidentDescription, $comments), "Content-type: text/html\r\n");
?>