EMAIL FORMATTING HAS SOME GLITCHES!!!!!!!!!
Posted: Sat Aug 22, 2009 3:03 pm
Please critique but I have a central question. This creates email message. But a few times in the body of the message it will, for instance, split a word with a line break or two. The code shows absolutely no line break. Otherwise, most everything else is fine, except the validator suddenly stopped working. But I'm more concerned with the email formmating. Does PHP kind of suck formatting emai??
---------------------
<?php
if(isset($_POST["Submit"]))
{
require("c:\php\includes\class.phpmailer.php");
$mail = new PHPMailer();
$toaddress = "XXXXXXXXXXXXXX"; //Change this to the email address you will be receiving your notices.
$mailhost = "XXXXXXXXXXXX"; //Change this to your actual Domain name.
$fromaddress = "XXXXXXXXXXXXXXX"; //Change this to the email address you will use to send and authenticate with.
$frompwd = "XXXXXXXXXXXX"; //Change this to the above email addresses password.
$subject = "XXXXXXXXXXXXXXX"; //Change this to your own email message subject.
$referredby = $_POST["Referredby"]; //This section takes data entered by form and puts it in a variable (dollar sign).
$fromname = $_POST["Name"];
$street = $_POST["Street"];
$city = $_POST["City"];
$state = $_POST["State"];
$zip = $_POST["Zip"];
$homephone = $_POST["Homephone"];
$workphone = $_POST["Workphone"];
$cellphone = $_POST["Cellphone"];
$rplyto = $_POST["Email"];
$youroccupation = $_POST["Youroccupation"];
$spousesoccupation = $_POST["Spousesoccupation"];
if (!isset($_POST['Appliedotherairedalerescue']))
{
//If not isset -> set with dumy value
$_POST['Appliedotherairedalerescue'] = "undefine";
}
$appliedotherairedalerescue = $_POST["Appliedotherairedalerescue"];
$appliedotherairedalerescuewho = $_POST["Appliedotherairedalerescuewho"];
$appliedotherairedalerescuedate = $_POST["Appliedotherairedalerescuedate"];
$appliedotherairedalerescuedetails = $_POST["Appliedotherairedalerescuedetails"];
if (!isset($_POST['Ownhome']))
{
//If not isset -> set with dumy value
$_POST['Ownhome'] = "undefine";
}
$ownhome = $_POST["Ownhome"];
if (!isset($_POST['Homeenvironment']))
{
//If not isset -> set with dumy value
$_POST['Homeenvironment'] = "undefine";
}
$homeenvironment = $_POST["Homeenvironment"];
$family = $_POST["Family"];
$ages = $_POST["Ages"];
if (!isset($_POST['Airedalefamilyconcensus']))
{
//If not isset -> set with dumy value
$_POST['Airedalefamilyconcensus'] = "undefine";
}
$airedalefamilyconcensus = $_POST["Airedalefamilyconcensus"];
$fencedinyard = $_POST["Fencedinyard"];
$kindoffence = $_POST["Kindoffence"];
$howhighfence = $_POST["Howhighfence"];
$sizeoffencedinarea = $_POST["Sizeoffencedinarea"];
$onedoortofencedyard = $_POST["Onedoortofencedyard"];
if (!isset($_POST['Swimmingpool']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpool'] = "undefine";
}
$swimmingpool = $_POST["Swimmingpool"];
if (!isset($_POST['Swimmingpoolseparatelyfenced']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpoolseparatelyfenced'] = "undefine";
}
$swimmingpoolseparatelyfenced = $_POST["Swimmingpoolseparatelyfenced"];
if (!isset($_POST['Swimmingpooldogproofsteps']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpooldogproofsteps'] = "undefine";
}
$swimmingpooldogproofsteps = $_POST["Swimmingpooldogproofsteps"];
$sex = $_POST["Sex"];
if (!isset($_POST['Age']))
{
//If not isset -> set with dumy value
$_POST['Age'] = "undefine";
}
$age = $_POST["Age"];
$size = $_POST["Size"];
if (!isset($_POST['Airedalemix']))
{
//If not isset -> set with dumy value
$_POST['Airedalemix'] = "undefine";
}
$airedalemix = $_POST["Airedalemix"];
$previouslyowned = $_POST["Previouslyowned"];
$whenpreviouslyowned = $_POST["Whenpreviouslyowned"];
$sexpreviouslyowned = $_POST["Sexpreviouslyowned"];
$otherbreeds = $_POST["Otherbreeds"];
if (!isset($_POST['Cats']))
{
//If not isset -> set with dumy value
$_POST['Cats'] = "undefine";
}
$cats = $_POST["Cats"];
if (!isset($_POST['Catsdogs']))
{
//If not isset -> set with dumy value
$_POST['Catsdogs'] = "undefine";
}
$catsdogs = $_POST["Catsdogs"];
$otherpets = $_POST["Otherpets"];
$otherpetsages = $_POST["Otherpetsages"];
$otherpetsspayedneutered = $_POST["Otherpetsspayedneutered"];
$a = $_POST["A"];
$fateoflasdivog = $_POST["Fateoflasdivog"];
$lostadog = $_POST["Lostadog"];
$movegiveupdog = $_POST["Movegiveupdog"];
if (!isset($_POST['Court']))
{
//If not isset -> set with dumy value
$_POST['Court'] = "undefine";
}
$court = $_POST["Court"];
$courtifsohow = $_POST["Courtifsohow"];
if (!isset($_POST['Readynow']))
{
//If not isset -> set with dumy value
$_POST['Readynow'] = "undefine";
}
$readynow = $_POST["Readynow"];
$readynowifnowhen = $_POST["Readynowifnowhen"];
$runofhouse = $_POST["Runofhouse"];
$allowedonfurniture = $_POST["Allowedonfurniture"];
$havebedandblanket = $_POST["Havebedandblanket"];
$dogbedinwhatroom = $_POST["Dogbedinwhatroom"];
$wherewillairedalesleep = $_POST["Wherewillairedalesleep"];
$hoursnoonehome = $_POST["Hoursnoonehome"];
$daysaweekalone = $_POST["Daysaweekalone"];
$whatroomabovetimes = $_POST["Whatroomabovetimes"];
$travelingwherewilldogstay = $_POST["Travelingwherewilldogstay"];
$familiardogcrate = $_POST["Familiardogcrate"];
$whencrate = $_POST["whencrate"];
$wherecrate = $_POST["wherecrate"];
$reference1 = $_POST["Reference1"];
$reference2 = $_POST["Reference2"];
$vetinfo = $_POST["Vetinfo"];
$comments = $_POST["Comments"];
$msgbody = "---------------PERSONAL INFORMATION--------------------------"
."<br>"
."Referred by = " . $referredby
."<br>"
."<br>"
."Your full name = " . $fromname
."<br>"
."Your street address = " . $street
."<br>"
."City = " . $city
."<br>"
."State = " . $state
."<br>"
."Zip code = " . $zip
."<br>"
."Your home telephone number (xxx-xxx-xxxx) or NA) = " . $homephone
."<br>"
."Your work number (xxx-xxx-xxxx) or NA) = " . $workphone
."<br>"
."Your cell phone number (xxx-xxx-xxxx) or NA) = " . $cellphone
."<br>"
."Email = " . $rplyto
."<br>"
."Your occupation = " . $youroccupation
."<br>"
."Your spouses occupation = " . $spousesoccupation
."<br>"
."Applied to another Airedale Rescue org? = " . $appliedotherairedalerescue ."," . $appliedotherairedalerescuewho ."," . $appliedotherairedalerescuedate ."," . $appliedotherairedalerescuedetails
."<br>"
."<br>"
."------------------ENVIRONMENT-----------------------"
."<br>"
."Do you own your home? = " . $ownhome
."<br>"
."Describe your home environment = " . $homeenvironment
."<br>"
."Family names = " . $family
."<br>"
."Family ages = " . $ages
."<br>"
."Does EVERY FAMILY MEMBER want an Airedale? = " . $airedalefamilyconcensus
."<br>"
."<br>"
."-------------YARD----------------------------"
."<br>"
."Do you have a fenced-in yard? = " . $fencedinyard
."<br>"
."What kind of fence? = " . $kindoffence
."<br>"
."How high is the fence? = " . $howhighfence
."<br>"
."Area?=" . $sizeoffencedinarea
."<br>"
."Yard access? = " . $onedoortofencedyard
."<br>"
."Pool? = " .$swimmingpool ."," .$swimmingpoolseparatelyfenced ."," .$swimmingpooldogproofsteps
."<br>"
."<br>"
."-------------AIREDALE PREFERENCES----------------------------"
."<br>"
."Gender preference? = " . $sex
."<br>"
."Age preference?=" . $age
."<br>"
."Size preference? = " . $size
."<br>"
."Airedale mix ok? = " . $airedalemix
."<br>"
."<br>"
."-----------------EXPERIENCE------------------------"
."<br>"
."Have you previously owned an Airedale? = " . $previouslyowned
."<br>"
."When? = " . $whenpreviouslyowned
."<br>"
."Male or female? = " . $sexpreviouslyowned
."<br>"
."What other dog breeds have you owned? = " . $otherbreeds
."<br>"
."Do you own cats? = " . $cats
."<br>"
."Are your cats compatible with dogs? = " . $catsdogs
."<br>"
."What other pets do you currently have? = " . $otherpets
."<br>"
."Your pets ages = " . $otherpetsages
."<br>"
."Are they spayed/neutered? = " . $otherpetsspayedneutered
."<br>"
."Are your dogs currently licensed? = " . $a
."<br>"
."What happened to your last dog? = " . $fateoflasdivog
."<br>"
."Have you ever lost a dog other than through death? = " . $lostadog
."<br>"
."If you had to move, would you consider giving up your dog? = " . $movegiveupdog
."<br>"
."Has your ownership of a dog ever caused you to be in a court situation? = " . $court
."<br>"
."If so, how? = " . $courtifsohow
."<br>"
."Are you ready for a dog now? = " . $readynow
."<br>"
."If not, what date did you have in mind? = " . $readynowifnowhen
."<br>"
."<br>"
."-------------------LIVING WITH YOUR DOG--------------------"
."<br>"
."Run of the house? = ". $runofhouse
."<br>"
."Be allowed on the furniture? = " . $allowedonfurniture
."<br>"
."Have his/her own dog bed and blankets? = " . $havebedandblanket
."<br>"
."In what room will the dog bed be placed? = " . $dogbedinwhatroom
."<br>"
."In what room will your new Airedale sleep? = " . $wherewillairedalesleep
."<br>"
."How many hours at a time is nobody at home? = " . $hoursnoonehome
."<br>"
."How many days a week will your dog be left alone? = " . $daysaweekalone
."<br>"
."In what room(s) will your dog be during the above times? = " . $whatroomabovetimes
."<br>"
."When you travel, where will your dog stay? = " . $travelingwherewilldogstay
."<br>"
."Are you familiar with a dog crate? = " . $familiardogcrate
."<br>"
."When do you use a crate? = " . $whencrate
."<br>"
."In what room will the crate be placed? = " . $wherecrate
."<br>"
."<br>"
."------------------PERSONAL REFERENCES-----------------------"
."<br>"
."Reference #1 Name, address, phone number? = " . $reference1
."<br>"
."<br>"
."Reference #2 Name, address, phone number? = " . $reference2
."<br>"
."<br>"
."------------------VETERINARIAN REFERENCES-----------------------"
."<br>"
."Your veterinarian's name, address, phone number? = " . $vetinfo
."<br>"
."<br>"
."----------------COMMENTS-------------------------"
."<br>"
."Comments? = " . $comments;
$mail->IsSMTP(); //This section sends mail
$mail->Host = $mailhost;
$mail->SMTPAuth = true;
$mail->Username = $fromaddress;
$mail->Password = $frompwd;
$mail->From = $fromaddress;
$mail->FromName = $fromname;
$mail->AddReplyTo($fromaddress);
$mail->AddAddress($toaddress);
$mail->IsHTML(true);
$mail->Subject = $subject;
$mail->Body = $msgbody;
if(!$mail->Send())
{
echo "Message could not be sent. <p>";
echo "Mailer Error: " . $mail->ErrorInfo;
exit;
}
header('Location:XXXXXXXXXXXXXXXXXXXX');
}
?>
<html>
<head>
<script language="JavaScript" src="validation.js"></script> <!-- This section validates the form by validation.js -->
<SCRIPT LANGUAGE="JavaScript">
function init() {
define('Referredby', 'string', 'Referred By?:');
define('Name', 'string', 'Name?:');
define('Street', 'string', 'Street?:');
define('City', 'string', 'City?:');
define('State', 'string', 'State?:');
define('Zip', 'string', 'Zip?:');
define('Homephone', 'string', 'Home phone?:');
define('Workphone', 'string', 'Work phone?:');
define('Cellphone', 'string', 'Cell phone?:');
define('Email', 'email', 'Email?:');
define('Youroccupation', 'email', 'Your Occupation?:');
define('Spousesoccupation', 'email', 'Your spouses occupation?:');
define('Appliedotherairedalerescue', 'string', 'Have you ever applied to another Airedale Rescue organization?:');
define('Appliedotherairedalerescuewho', 'string', 'If so, which?');
define('Appliedotherairedalerescuedate', 'string', 'Date of application?:');
define('Appliedotherairedalerescuedetails', 'string', 'Pertinent details?:');
define('Ownhome', 'string', 'Do you own your home?:');
define('Homeenvironment', 'string', 'Is your home environment?:');
define('Family', 'string', 'Please list the names of all family members (including yourself), live-in help, frequent visitors, etc?:');
define('Ages', 'string', 'Please list the ages of all family members (including yourself), live-in help, frequent visitors, etc?:');
define('Airedalefamilyconcensus', 'string', 'Does EVERY FAMILY MEMBER want an Airedale?:');
define('Fencedinyard', 'string', 'Do you have a fenced-in-yard?:');
define('Kindoffence', 'string', 'What kind of fence?:');
define('Howhighfence', 'string', 'How high is the fence?:');
define('Sizeoffencedinarea', 'string', 'Size of fenced-in area?:');
define('Onedoortofencedyard', 'string', 'Size of fenced-in area?:');
define('Swimmingpool', 'string', 'Do You Have A Swimming Pool?:');
define('Swimmingpoolseparatelyfenced', 'string', 'Is Your Pool Separately Fenced?:');
define('Swimmingpooldogproofsteps', 'string', 'Does Your Pool Have "Dog-Proof" Steps?:');
define('Sex', 'string', 'Do you prefer a male or a female Airedale?:');
define('Age', 'string', 'Do you have an age preference?:');
define('Size', 'string', 'Do you have a size preference?:');
define('Airedalemix', 'string', 'Would you consider an Airedale mix?:');
define('previouslyowned', 'string', 'Have you previously owned an Airedale?:');
define('Whenpreviouslyowned', 'string', 'When?:');
define('Sexpreviouslyowned', 'string', 'Male or female?:');
define('Otherbreeds', 'string', 'What other dog breeds have you owned?:');
define('Cats', 'string', 'Do you own cats?:');
define('Catsdogs', 'string', 'Are your cats compatible with dogs?:');
define('Otherpets', 'string', 'What other pets do you currently have?:');
define('Otherpetsages', 'string', 'Your pets ages?:');
define('Otherpetsspayedneutered', 'string', 'Are they spayed/neutered?:');
define('A', 'string', 'Are your dogs currently licensed?:');
define('Fateoflasdivog', 'string', 'What happened to your last dog?:');
define('Lostadog', 'string', 'Have you ever lost a dog other than thru death?:');
define('Movegiveupdog', 'string', 'If you had to move, would you consider giving up your dog?:');
define('Court', 'string', 'Has Ownership Of A Dog Ever Caused You To Be In A Court Situation?:');
define('Courtifsohow', 'string', 'If so, How?:');
define('Readynow', 'string', 'Are you ready for a dog now?:');
define('Readynowifnotwhen', 'string', 'If not, what date did you have in mind?:');
define('Runofthehouse', 'string', 'Will your new Airedale have "run of the house"?:');
define('Allowedonfurniture', 'string', 'Be allowed on the furniture?:');
define('Havebedandblanket', 'string', 'Have his/her own dog bed and blankets?:');
define('Dogbedinwhatroom', 'string', 'In what room will the dog bed be placed?');
define('Wherewillairedalesleep', 'string', 'In what room will your new Airedale sleep?:');
define('Hoursnoonehome', 'string', 'How many hours at a time is no one at home?:');
define('Daysaweekalone', 'string', 'How many days a week will your dog be left alone?:');
define('Whatroomabovetimes', 'string', 'In what room(s) will your dog be during the above times?:');
define('Travelingwherewilldogstay', 'string', 'When you travel, where will your dog stay?:');
define('Familiardogcrate', 'string', 'Are you familiar with a dog crate?:');
define('whencrate', 'string', 'When and where do you use one?:');
define('wherecrate', 'string', 'In what room will you use a crate?:');
define('Reference1', 'string', 'REFERENCE 1: Name, address, phone number?:');
define('Reference2', 'string', 'REFERENCE 2: Name, address, phone number?:');
define('Vetinfo', 'string', 'Your veterinarian name, address, phone number?:');
define('Comments', 'string', 'Comments?:');
}
</script>
<style>
.mystyle {font-size:15px; font-weight:Bold; font-family:Arial, Helvetica, sans-serif; font-variant:normal; letter-spacing:normal; font-size-adjust:inherit;}
.style1 {
color: #C66300;
font-family: Arial, Helvetica, sans-serif;
font-size: 16px;
font-weight:bold;}
.style2 {color: #C66300; font-family: Arial, Helvetica, sans-serif; font-size: 18px; font-weight: bold; }
.style3 {
font-family: "Times New Roman", Times, serif;
font-size: 24px;
}
.style4 {color: #C66300; font-family: "Times New Roman", Times, serif; font-size: 24px; font-weight: bold; }
</style>
</script>
</head>
<BODY OnLoad="init()">
<form name="SendEmail01" method="post"> <!-- This section is the web form that creates the data -->
<span class="style3"><br>
</span>
<div class="style4">
ONLINE ADOPTION APPLICATION FORM</div>
<br><br>
<div class="style2">
Part 1: PERSONAL INFORMATION</div>
<br><br><br>
<div class="style1">Referred by?:</div><br>
<div><input name="Referredby" type="text" class="mystyle" size="30" font=times></div>
<br><br>
<div height="60" class="style1">Your Full Name?:</div><br>
<div><input name="Name" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your Street Address?:</div><br>
<div><input name="Street" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">City?:</div><br>
<div><input name="City" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">State?:</div><br>
<div><input name="State" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Zip Code (5 digits only)?:</div><br>
<div><input name="Zip" type="text" class="mystyle" size="6" maxlength="5"></div>
<br><br>
<div height="60" class="style1">Your home telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Homephone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Your work telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Workphone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Your cell telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Cellphone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Email?:</div><br>
<div><input name="Email" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your Occupation?:</div><br>
<div><input name="Youroccupation" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Spouse's Occupation?:</div><br>
<div><input name="Spousesoccupation" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Have you ever applied to another Airedale Rescue organization?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Appliedotherairedalerescue" value="Yes">Yes<br>
<input type="radio" name="Appliedotherairedalerescue" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If so, which?:</div><br>
<div><input name="Appliedotherairedalerescuewho" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Date of Application?:</div><br>
<div><input name="Appliedotherairedalerescuedate" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Pertinent Details?:</div><br>
<div><textarea name="Appliedotherairedalerescuedetails" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 2: ENVIRONMENT</div>
<br><br>
<div height="60" class="style1">Do you own your home?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Ownhome" value="Yes, we own our house">Yes, we own our house<br>
<input type="radio" name="Ownhome" value="No, we rent/lease a house">No, we rent/lease a house<br>
<input type="radio" name="Ownhome" value="No, we own our condominium">No, we own our condominium<br>
<input type="radio" name="Ownhome" value="No, we rent/lease a condominium">No, we rent/lease a condominium<br>
<input type="radio" name="Ownhome" value="No, we rent/lease an apartment">No, we rent/lease an apartment<br>
</div>
<br><br>
<div height="60" class="style1">Describe your home environment?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Homeenvironment" value="Urban">Urban<br>
<input type="radio" name="Homeenvironment" value="Suburban">Suburban<br>
<input type="radio" name="Homeenvironment" value="Rural">Rural<br>
</div>
<br><br>
<div height="80" class="style1">Please list the NAMES of all family <br>
members (including yourself),<br>
live-in help, frequent visitors, etc?:</div><br>
<div><textarea name="Family" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="80" class="style1">Please list the ages of all family <br>
members (including yourself), <br>
live-in help, frequent visitors, etc?:</div>
<br>
<div><textarea name="Ages" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="60" class="style1">Does EVERY FAMILY MEMBER want an Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Airedalefamilyconcensus" value="Yes">Yes<br>
<input type="radio" name="Airedalefamilyconcensus" value="No">No<br>
</div>
<br><br>
<div class="style2">
Part 3: YARD</div>
<br><br>
<div height="60" class="style1">Do you have a fenced-in yard?:</div><br>
<div><input name="Fencedinyard" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">What kind of fence?:</div><br>
<div><input name="Kindoffence" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How high is the fence?:</div><br>
<div><input name="Howhighfence" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Size of fenced-in area?:</div><br>
<div><input name="Sizeoffencedinarea" type="text" class="mystyle" size="30" ></div>
<br><br>
<div height="60" class="style1">Does at least one door of the house open directly into the fenced in yard?:</div><br>
<div><input name="Onedoortofencedyard" type="text" class="mystyle" size="30" ></div>
<br><br>
<div height="60" class="style1">Do you have a swimming pool?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpool" value="No, we do not have a pool">No, we do not have a pool<br>
<input type="radio" name="Swimmingpool" value="Yes">Yes, in-ground<br>
<input type="radio" name="Swimmingpool" value="Yes">Yes, above ground<br>
</div>
<br><br>
<div height="60" class="style1">Is your pool separately fenced?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="Yes">Yes<br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="No">No<br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="NA">NA<br>
</div>
<br><br>
<div height="60" class="style1">Does your pool have "dog-proof" steps?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpooldogproofsteps" value="Yes">Yes<br>
<input type="radio" name="Swimmingpooldogproofsteps" value="No">No<br>
<input type="radio" name="Swimmingpooldogproofsteps" value="NA">NA<br>
</div>
<br><br>
<div class="style2">
Part 4: AIREDALE PREFERENCES</div>
<br><br>
<div height="60" class="style1">Do you prefer a male or female?:<br>
Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Sex" value="Male"> Male <br>
<input type="radio" name="Sex" value="Female"> Female<br>
<input type="radio" name="Sex" value="No preference" checked="checked"> No Preference<br>
</div><br>
<div height="60" class="style1">Do you have an age preference?:</div><br>
<div class="mystyle"><br>
<input name="age" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Do you have a size preference?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Size" value="Under 60 pounds"> Under 60 pounds <br>
<input type="radio" name="Size" value="Over 60 pounds"> Over 60 pounds<br>
<input type="radio" name="Size" value="No preference" checked="checked"> No Preference<br>
</div><br>
<br>
<br>
<div height="60" class="style1">Would you consider an Airedale mix?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Airedalemix" value="Yes">Yes<br>
<input type="radio" name="Airedalemix" value="No">No<br>
</div>
<br><br>
<div class="style2">
Part 5: EXPERIENCE</div>
<br><br>
<div height="60" class="style1">Have you previously owned an <br>
Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Previouslyowned" value="Yes"> Yes <br>
<input type="radio" name="Previouslyowned" value="No" checked="checked"> No <br>
</div>
<br><br>
<div height="60" class="style1">When?:</div><br>
<div class="mystyle"><br>
<input name="Whenpreviouslyowned" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Male or Female?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Sexpreviouslyowned" value="Male"> Male <br>
<input type="radio" name="Sexpreviouslyowned" value="Female"> Female<br>
<input type="radio" name="Sexpreviouslyowned" value="Both"> Both<br>
<input type="radio" name="Sexpreviouslyowned" value="N/A" checked="checked"> N/A</div><br><br>
<div height="60" class="style1">What other dog breeds have <br>
you owned?:</div><br>
<div><input name="Otherbreeds" type="text" class="mystyle" size="30"></div>
<br>
<br>
<br>
<div height="60" class="style1">Do you own cats?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Cats" value="No">No<br>
<input type="radio" name="Cats" value="Yes, my cats are house pets">Yes, my cats are house pets<br>
<input type="radio" name="Cats" value="Yes, my cats are outdoor cats">Yes, my cats are outdoor cats<br>
<input type="radio" name="Cats" value="No, just strays">No, just strays<br>
</div>
<br><br>
<br>
<br>
<div height="60" class="style1">Are your cats compatible with dogs?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Catsdogs" value="Yes">Yes<br>
<input type="radio" name="Catsdogs" value="No">No<br>
<input type="radio" name="Catsdogs" value="NA">NA<br>
</div>
<br><br>
<br>
<br>
<div height="60" class="style1">What other pets do you currently
<br>have?:</div><br>
<div><input name="Otherpets" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your pets ages:</div><br>
<div><input name="Otherpetsages" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are they spayed/neutered?:</div><br>
<div><input name="Otherpetsspayedneutered" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are your dogs currently licensed?:</div><br>
<div><input name="A" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">What happened to your last dog?:</div><br>
<div><input name="Fateoflasdivog" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Have you ever lost a dog other <br>
than through death?:</div><br>
<div><input name="Lostadog" type="text" class="mystyle" size="30">
</div>
<br><br>
<div height="60" class="style1">If you had to move, would you
<br>consider giving up your dog?:</div><br>
<div><input name="Movegiveupdog" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Has ownership of a dog ever caused you to be in a court situation?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Court" value="Yes">Yes<br>
<input type="radio" name="Court" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If so, how?:</div><br>
<div><input name="Courtifsohow" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are you ready for a dog now?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Readynow" value="Yes">Yes<br>
<input type="radio" name="Readynow" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If not, what date did you have in mind?:</div><br>
<div><input name="Readynowifnowhen" type="text" class="mystyle" size="30"></div>
<br><br>
<div class="style2">
Part 6: LIVING WITH YOUR DOG</div>
<br><br>
<div height="60" class="style1">Will your new Airedale have
<br>"run of the house"?:</div><br>
<div class="mystyle"> <br>
<input type="radio" name="Runofhouse" value="Yes"> Yes
<br><input type="radio" name="Runofhouse" value="No" checked="checked"> No</div><br><br>
<div height="60" class="style1">Be allowed on the furniture?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Allowedonfurniture" value="Yes"> Yes <br>
<input type="radio" name="Allowedonfurniture" value="No" checked="checked"> No <br>
</div><br><br>
<div height="60" class="style1">
<p>Have his/her own dog bed and
<br>
blankets?:</div><br>
<div class="mystyle"><input type="radio" name="Havebedandblanket" value="Yes"> Yes <br>
<input type="radio" name="Havebedandblanket" value="No" checked="checked"> No <br><br>
</div>
<br><br>
<div height="60" class="style1">In what room will the dog bed be
<br>
placed?:</div><br>
<div><input name="Dogbedinwhatroom" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">In what room will your new
<br>Airedale sleep?:</div><br>
<div><input name="Wherewillairedalesleep" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How many hours at a time is no
<br>
one at home?:</div><br>
<div><input name="Hoursnoonehome" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How many days a week will your
<br>
dog be left alone?:</div><br>
<div><input name="Daysaweekalone" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">In what room(s) will your dog be
<br>during the above times?:</div><br>
<div><input name="Whatroomabovetimes" type="text" class="mystyle" size="30">
</div>
<br><br>
<div height="60" class="style1">When you travel, where will your
<br>dog stay?:</div><br>
<div><input name="Travelingwherewilldogstay" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are you familiar with a dog crate?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Familiardogcrate" value="Yes">Yes</span> <br>
<input type="radio" name="Familiardogcrate" value="No" checked="checked">No</span></div><br><br>
<div height="80" class="style1">When do you use a crate?:</div><br>
<div><textarea name="whencrate" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="80" class="style1">In what room will you use a crate?:</div><br>
<div><textarea name="wherecrate" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 7: PERSONAL REFERENCES</div>
<br><br>
<div height="80" class="style1">REFERENCES: Name, address,
<br>
phone number:</div><br>
<div><textarea name="Reference1" cols="30" rows="4" class="mystyle"></textarea></div><br>
<br><br>
<div height="80" class="style1">REFERENCES: Name, address,
<br>
phone number:</div><br>
<div><textarea name="Reference2" cols="30" rows="4" class="mystyle"></textarea></div><br>
<br><br>
<div class="style2">
Part 8: VETERINARIAN REFERENCE</div>
<br><br>
<div height="80" class="style1">Veterinarian's name, address,
<br>phone number:</div><br>
<div><textarea name="Vetinfo" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 9: COMMENTS</div>
<br><br>
<div height="60" class="style1">Comments:</div><br>
<div><textarea name="Comments" cols="30" rows="8" class="mystyle"></textarea></div>
<br><br>
<!-- This section is the web form that creates the data-->
<div><input type="submit" name="Submit" value="Submit" onClick="validate();return returnVal;" value="Test fields"></div>
</form>
</body>
</html>
---------------------
<?php
if(isset($_POST["Submit"]))
{
require("c:\php\includes\class.phpmailer.php");
$mail = new PHPMailer();
$toaddress = "XXXXXXXXXXXXXX"; //Change this to the email address you will be receiving your notices.
$mailhost = "XXXXXXXXXXXX"; //Change this to your actual Domain name.
$fromaddress = "XXXXXXXXXXXXXXX"; //Change this to the email address you will use to send and authenticate with.
$frompwd = "XXXXXXXXXXXX"; //Change this to the above email addresses password.
$subject = "XXXXXXXXXXXXXXX"; //Change this to your own email message subject.
$referredby = $_POST["Referredby"]; //This section takes data entered by form and puts it in a variable (dollar sign).
$fromname = $_POST["Name"];
$street = $_POST["Street"];
$city = $_POST["City"];
$state = $_POST["State"];
$zip = $_POST["Zip"];
$homephone = $_POST["Homephone"];
$workphone = $_POST["Workphone"];
$cellphone = $_POST["Cellphone"];
$rplyto = $_POST["Email"];
$youroccupation = $_POST["Youroccupation"];
$spousesoccupation = $_POST["Spousesoccupation"];
if (!isset($_POST['Appliedotherairedalerescue']))
{
//If not isset -> set with dumy value
$_POST['Appliedotherairedalerescue'] = "undefine";
}
$appliedotherairedalerescue = $_POST["Appliedotherairedalerescue"];
$appliedotherairedalerescuewho = $_POST["Appliedotherairedalerescuewho"];
$appliedotherairedalerescuedate = $_POST["Appliedotherairedalerescuedate"];
$appliedotherairedalerescuedetails = $_POST["Appliedotherairedalerescuedetails"];
if (!isset($_POST['Ownhome']))
{
//If not isset -> set with dumy value
$_POST['Ownhome'] = "undefine";
}
$ownhome = $_POST["Ownhome"];
if (!isset($_POST['Homeenvironment']))
{
//If not isset -> set with dumy value
$_POST['Homeenvironment'] = "undefine";
}
$homeenvironment = $_POST["Homeenvironment"];
$family = $_POST["Family"];
$ages = $_POST["Ages"];
if (!isset($_POST['Airedalefamilyconcensus']))
{
//If not isset -> set with dumy value
$_POST['Airedalefamilyconcensus'] = "undefine";
}
$airedalefamilyconcensus = $_POST["Airedalefamilyconcensus"];
$fencedinyard = $_POST["Fencedinyard"];
$kindoffence = $_POST["Kindoffence"];
$howhighfence = $_POST["Howhighfence"];
$sizeoffencedinarea = $_POST["Sizeoffencedinarea"];
$onedoortofencedyard = $_POST["Onedoortofencedyard"];
if (!isset($_POST['Swimmingpool']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpool'] = "undefine";
}
$swimmingpool = $_POST["Swimmingpool"];
if (!isset($_POST['Swimmingpoolseparatelyfenced']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpoolseparatelyfenced'] = "undefine";
}
$swimmingpoolseparatelyfenced = $_POST["Swimmingpoolseparatelyfenced"];
if (!isset($_POST['Swimmingpooldogproofsteps']))
{
//If not isset -> set with dumy value
$_POST['Swimmingpooldogproofsteps'] = "undefine";
}
$swimmingpooldogproofsteps = $_POST["Swimmingpooldogproofsteps"];
$sex = $_POST["Sex"];
if (!isset($_POST['Age']))
{
//If not isset -> set with dumy value
$_POST['Age'] = "undefine";
}
$age = $_POST["Age"];
$size = $_POST["Size"];
if (!isset($_POST['Airedalemix']))
{
//If not isset -> set with dumy value
$_POST['Airedalemix'] = "undefine";
}
$airedalemix = $_POST["Airedalemix"];
$previouslyowned = $_POST["Previouslyowned"];
$whenpreviouslyowned = $_POST["Whenpreviouslyowned"];
$sexpreviouslyowned = $_POST["Sexpreviouslyowned"];
$otherbreeds = $_POST["Otherbreeds"];
if (!isset($_POST['Cats']))
{
//If not isset -> set with dumy value
$_POST['Cats'] = "undefine";
}
$cats = $_POST["Cats"];
if (!isset($_POST['Catsdogs']))
{
//If not isset -> set with dumy value
$_POST['Catsdogs'] = "undefine";
}
$catsdogs = $_POST["Catsdogs"];
$otherpets = $_POST["Otherpets"];
$otherpetsages = $_POST["Otherpetsages"];
$otherpetsspayedneutered = $_POST["Otherpetsspayedneutered"];
$a = $_POST["A"];
$fateoflasdivog = $_POST["Fateoflasdivog"];
$lostadog = $_POST["Lostadog"];
$movegiveupdog = $_POST["Movegiveupdog"];
if (!isset($_POST['Court']))
{
//If not isset -> set with dumy value
$_POST['Court'] = "undefine";
}
$court = $_POST["Court"];
$courtifsohow = $_POST["Courtifsohow"];
if (!isset($_POST['Readynow']))
{
//If not isset -> set with dumy value
$_POST['Readynow'] = "undefine";
}
$readynow = $_POST["Readynow"];
$readynowifnowhen = $_POST["Readynowifnowhen"];
$runofhouse = $_POST["Runofhouse"];
$allowedonfurniture = $_POST["Allowedonfurniture"];
$havebedandblanket = $_POST["Havebedandblanket"];
$dogbedinwhatroom = $_POST["Dogbedinwhatroom"];
$wherewillairedalesleep = $_POST["Wherewillairedalesleep"];
$hoursnoonehome = $_POST["Hoursnoonehome"];
$daysaweekalone = $_POST["Daysaweekalone"];
$whatroomabovetimes = $_POST["Whatroomabovetimes"];
$travelingwherewilldogstay = $_POST["Travelingwherewilldogstay"];
$familiardogcrate = $_POST["Familiardogcrate"];
$whencrate = $_POST["whencrate"];
$wherecrate = $_POST["wherecrate"];
$reference1 = $_POST["Reference1"];
$reference2 = $_POST["Reference2"];
$vetinfo = $_POST["Vetinfo"];
$comments = $_POST["Comments"];
$msgbody = "---------------PERSONAL INFORMATION--------------------------"
."<br>"
."Referred by = " . $referredby
."<br>"
."<br>"
."Your full name = " . $fromname
."<br>"
."Your street address = " . $street
."<br>"
."City = " . $city
."<br>"
."State = " . $state
."<br>"
."Zip code = " . $zip
."<br>"
."Your home telephone number (xxx-xxx-xxxx) or NA) = " . $homephone
."<br>"
."Your work number (xxx-xxx-xxxx) or NA) = " . $workphone
."<br>"
."Your cell phone number (xxx-xxx-xxxx) or NA) = " . $cellphone
."<br>"
."Email = " . $rplyto
."<br>"
."Your occupation = " . $youroccupation
."<br>"
."Your spouses occupation = " . $spousesoccupation
."<br>"
."Applied to another Airedale Rescue org? = " . $appliedotherairedalerescue ."," . $appliedotherairedalerescuewho ."," . $appliedotherairedalerescuedate ."," . $appliedotherairedalerescuedetails
."<br>"
."<br>"
."------------------ENVIRONMENT-----------------------"
."<br>"
."Do you own your home? = " . $ownhome
."<br>"
."Describe your home environment = " . $homeenvironment
."<br>"
."Family names = " . $family
."<br>"
."Family ages = " . $ages
."<br>"
."Does EVERY FAMILY MEMBER want an Airedale? = " . $airedalefamilyconcensus
."<br>"
."<br>"
."-------------YARD----------------------------"
."<br>"
."Do you have a fenced-in yard? = " . $fencedinyard
."<br>"
."What kind of fence? = " . $kindoffence
."<br>"
."How high is the fence? = " . $howhighfence
."<br>"
."Area?=" . $sizeoffencedinarea
."<br>"
."Yard access? = " . $onedoortofencedyard
."<br>"
."Pool? = " .$swimmingpool ."," .$swimmingpoolseparatelyfenced ."," .$swimmingpooldogproofsteps
."<br>"
."<br>"
."-------------AIREDALE PREFERENCES----------------------------"
."<br>"
."Gender preference? = " . $sex
."<br>"
."Age preference?=" . $age
."<br>"
."Size preference? = " . $size
."<br>"
."Airedale mix ok? = " . $airedalemix
."<br>"
."<br>"
."-----------------EXPERIENCE------------------------"
."<br>"
."Have you previously owned an Airedale? = " . $previouslyowned
."<br>"
."When? = " . $whenpreviouslyowned
."<br>"
."Male or female? = " . $sexpreviouslyowned
."<br>"
."What other dog breeds have you owned? = " . $otherbreeds
."<br>"
."Do you own cats? = " . $cats
."<br>"
."Are your cats compatible with dogs? = " . $catsdogs
."<br>"
."What other pets do you currently have? = " . $otherpets
."<br>"
."Your pets ages = " . $otherpetsages
."<br>"
."Are they spayed/neutered? = " . $otherpetsspayedneutered
."<br>"
."Are your dogs currently licensed? = " . $a
."<br>"
."What happened to your last dog? = " . $fateoflasdivog
."<br>"
."Have you ever lost a dog other than through death? = " . $lostadog
."<br>"
."If you had to move, would you consider giving up your dog? = " . $movegiveupdog
."<br>"
."Has your ownership of a dog ever caused you to be in a court situation? = " . $court
."<br>"
."If so, how? = " . $courtifsohow
."<br>"
."Are you ready for a dog now? = " . $readynow
."<br>"
."If not, what date did you have in mind? = " . $readynowifnowhen
."<br>"
."<br>"
."-------------------LIVING WITH YOUR DOG--------------------"
."<br>"
."Run of the house? = ". $runofhouse
."<br>"
."Be allowed on the furniture? = " . $allowedonfurniture
."<br>"
."Have his/her own dog bed and blankets? = " . $havebedandblanket
."<br>"
."In what room will the dog bed be placed? = " . $dogbedinwhatroom
."<br>"
."In what room will your new Airedale sleep? = " . $wherewillairedalesleep
."<br>"
."How many hours at a time is nobody at home? = " . $hoursnoonehome
."<br>"
."How many days a week will your dog be left alone? = " . $daysaweekalone
."<br>"
."In what room(s) will your dog be during the above times? = " . $whatroomabovetimes
."<br>"
."When you travel, where will your dog stay? = " . $travelingwherewilldogstay
."<br>"
."Are you familiar with a dog crate? = " . $familiardogcrate
."<br>"
."When do you use a crate? = " . $whencrate
."<br>"
."In what room will the crate be placed? = " . $wherecrate
."<br>"
."<br>"
."------------------PERSONAL REFERENCES-----------------------"
."<br>"
."Reference #1 Name, address, phone number? = " . $reference1
."<br>"
."<br>"
."Reference #2 Name, address, phone number? = " . $reference2
."<br>"
."<br>"
."------------------VETERINARIAN REFERENCES-----------------------"
."<br>"
."Your veterinarian's name, address, phone number? = " . $vetinfo
."<br>"
."<br>"
."----------------COMMENTS-------------------------"
."<br>"
."Comments? = " . $comments;
$mail->IsSMTP(); //This section sends mail
$mail->Host = $mailhost;
$mail->SMTPAuth = true;
$mail->Username = $fromaddress;
$mail->Password = $frompwd;
$mail->From = $fromaddress;
$mail->FromName = $fromname;
$mail->AddReplyTo($fromaddress);
$mail->AddAddress($toaddress);
$mail->IsHTML(true);
$mail->Subject = $subject;
$mail->Body = $msgbody;
if(!$mail->Send())
{
echo "Message could not be sent. <p>";
echo "Mailer Error: " . $mail->ErrorInfo;
exit;
}
header('Location:XXXXXXXXXXXXXXXXXXXX');
}
?>
<html>
<head>
<script language="JavaScript" src="validation.js"></script> <!-- This section validates the form by validation.js -->
<SCRIPT LANGUAGE="JavaScript">
function init() {
define('Referredby', 'string', 'Referred By?:');
define('Name', 'string', 'Name?:');
define('Street', 'string', 'Street?:');
define('City', 'string', 'City?:');
define('State', 'string', 'State?:');
define('Zip', 'string', 'Zip?:');
define('Homephone', 'string', 'Home phone?:');
define('Workphone', 'string', 'Work phone?:');
define('Cellphone', 'string', 'Cell phone?:');
define('Email', 'email', 'Email?:');
define('Youroccupation', 'email', 'Your Occupation?:');
define('Spousesoccupation', 'email', 'Your spouses occupation?:');
define('Appliedotherairedalerescue', 'string', 'Have you ever applied to another Airedale Rescue organization?:');
define('Appliedotherairedalerescuewho', 'string', 'If so, which?');
define('Appliedotherairedalerescuedate', 'string', 'Date of application?:');
define('Appliedotherairedalerescuedetails', 'string', 'Pertinent details?:');
define('Ownhome', 'string', 'Do you own your home?:');
define('Homeenvironment', 'string', 'Is your home environment?:');
define('Family', 'string', 'Please list the names of all family members (including yourself), live-in help, frequent visitors, etc?:');
define('Ages', 'string', 'Please list the ages of all family members (including yourself), live-in help, frequent visitors, etc?:');
define('Airedalefamilyconcensus', 'string', 'Does EVERY FAMILY MEMBER want an Airedale?:');
define('Fencedinyard', 'string', 'Do you have a fenced-in-yard?:');
define('Kindoffence', 'string', 'What kind of fence?:');
define('Howhighfence', 'string', 'How high is the fence?:');
define('Sizeoffencedinarea', 'string', 'Size of fenced-in area?:');
define('Onedoortofencedyard', 'string', 'Size of fenced-in area?:');
define('Swimmingpool', 'string', 'Do You Have A Swimming Pool?:');
define('Swimmingpoolseparatelyfenced', 'string', 'Is Your Pool Separately Fenced?:');
define('Swimmingpooldogproofsteps', 'string', 'Does Your Pool Have "Dog-Proof" Steps?:');
define('Sex', 'string', 'Do you prefer a male or a female Airedale?:');
define('Age', 'string', 'Do you have an age preference?:');
define('Size', 'string', 'Do you have a size preference?:');
define('Airedalemix', 'string', 'Would you consider an Airedale mix?:');
define('previouslyowned', 'string', 'Have you previously owned an Airedale?:');
define('Whenpreviouslyowned', 'string', 'When?:');
define('Sexpreviouslyowned', 'string', 'Male or female?:');
define('Otherbreeds', 'string', 'What other dog breeds have you owned?:');
define('Cats', 'string', 'Do you own cats?:');
define('Catsdogs', 'string', 'Are your cats compatible with dogs?:');
define('Otherpets', 'string', 'What other pets do you currently have?:');
define('Otherpetsages', 'string', 'Your pets ages?:');
define('Otherpetsspayedneutered', 'string', 'Are they spayed/neutered?:');
define('A', 'string', 'Are your dogs currently licensed?:');
define('Fateoflasdivog', 'string', 'What happened to your last dog?:');
define('Lostadog', 'string', 'Have you ever lost a dog other than thru death?:');
define('Movegiveupdog', 'string', 'If you had to move, would you consider giving up your dog?:');
define('Court', 'string', 'Has Ownership Of A Dog Ever Caused You To Be In A Court Situation?:');
define('Courtifsohow', 'string', 'If so, How?:');
define('Readynow', 'string', 'Are you ready for a dog now?:');
define('Readynowifnotwhen', 'string', 'If not, what date did you have in mind?:');
define('Runofthehouse', 'string', 'Will your new Airedale have "run of the house"?:');
define('Allowedonfurniture', 'string', 'Be allowed on the furniture?:');
define('Havebedandblanket', 'string', 'Have his/her own dog bed and blankets?:');
define('Dogbedinwhatroom', 'string', 'In what room will the dog bed be placed?');
define('Wherewillairedalesleep', 'string', 'In what room will your new Airedale sleep?:');
define('Hoursnoonehome', 'string', 'How many hours at a time is no one at home?:');
define('Daysaweekalone', 'string', 'How many days a week will your dog be left alone?:');
define('Whatroomabovetimes', 'string', 'In what room(s) will your dog be during the above times?:');
define('Travelingwherewilldogstay', 'string', 'When you travel, where will your dog stay?:');
define('Familiardogcrate', 'string', 'Are you familiar with a dog crate?:');
define('whencrate', 'string', 'When and where do you use one?:');
define('wherecrate', 'string', 'In what room will you use a crate?:');
define('Reference1', 'string', 'REFERENCE 1: Name, address, phone number?:');
define('Reference2', 'string', 'REFERENCE 2: Name, address, phone number?:');
define('Vetinfo', 'string', 'Your veterinarian name, address, phone number?:');
define('Comments', 'string', 'Comments?:');
}
</script>
<style>
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.style1 {
color: #C66300;
font-family: Arial, Helvetica, sans-serif;
font-size: 16px;
font-weight:bold;}
.style2 {color: #C66300; font-family: Arial, Helvetica, sans-serif; font-size: 18px; font-weight: bold; }
.style3 {
font-family: "Times New Roman", Times, serif;
font-size: 24px;
}
.style4 {color: #C66300; font-family: "Times New Roman", Times, serif; font-size: 24px; font-weight: bold; }
</style>
</script>
</head>
<BODY OnLoad="init()">
<form name="SendEmail01" method="post"> <!-- This section is the web form that creates the data -->
<span class="style3"><br>
</span>
<div class="style4">
ONLINE ADOPTION APPLICATION FORM</div>
<br><br>
<div class="style2">
Part 1: PERSONAL INFORMATION</div>
<br><br><br>
<div class="style1">Referred by?:</div><br>
<div><input name="Referredby" type="text" class="mystyle" size="30" font=times></div>
<br><br>
<div height="60" class="style1">Your Full Name?:</div><br>
<div><input name="Name" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your Street Address?:</div><br>
<div><input name="Street" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">City?:</div><br>
<div><input name="City" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">State?:</div><br>
<div><input name="State" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Zip Code (5 digits only)?:</div><br>
<div><input name="Zip" type="text" class="mystyle" size="6" maxlength="5"></div>
<br><br>
<div height="60" class="style1">Your home telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Homephone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Your work telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Workphone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Your cell telephone number <br>
(xxx-xxx-xxxx) or NA?: </div>
<br>
<div><input name="Cellphone" type="text" class="mystyle" size="13" maxlength="12"></div>
<br><br>
<div height="60" class="style1">Email?:</div><br>
<div><input name="Email" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your Occupation?:</div><br>
<div><input name="Youroccupation" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Spouse's Occupation?:</div><br>
<div><input name="Spousesoccupation" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Have you ever applied to another Airedale Rescue organization?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Appliedotherairedalerescue" value="Yes">Yes<br>
<input type="radio" name="Appliedotherairedalerescue" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If so, which?:</div><br>
<div><input name="Appliedotherairedalerescuewho" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Date of Application?:</div><br>
<div><input name="Appliedotherairedalerescuedate" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Pertinent Details?:</div><br>
<div><textarea name="Appliedotherairedalerescuedetails" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 2: ENVIRONMENT</div>
<br><br>
<div height="60" class="style1">Do you own your home?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Ownhome" value="Yes, we own our house">Yes, we own our house<br>
<input type="radio" name="Ownhome" value="No, we rent/lease a house">No, we rent/lease a house<br>
<input type="radio" name="Ownhome" value="No, we own our condominium">No, we own our condominium<br>
<input type="radio" name="Ownhome" value="No, we rent/lease a condominium">No, we rent/lease a condominium<br>
<input type="radio" name="Ownhome" value="No, we rent/lease an apartment">No, we rent/lease an apartment<br>
</div>
<br><br>
<div height="60" class="style1">Describe your home environment?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Homeenvironment" value="Urban">Urban<br>
<input type="radio" name="Homeenvironment" value="Suburban">Suburban<br>
<input type="radio" name="Homeenvironment" value="Rural">Rural<br>
</div>
<br><br>
<div height="80" class="style1">Please list the NAMES of all family <br>
members (including yourself),<br>
live-in help, frequent visitors, etc?:</div><br>
<div><textarea name="Family" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="80" class="style1">Please list the ages of all family <br>
members (including yourself), <br>
live-in help, frequent visitors, etc?:</div>
<br>
<div><textarea name="Ages" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="60" class="style1">Does EVERY FAMILY MEMBER want an Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Airedalefamilyconcensus" value="Yes">Yes<br>
<input type="radio" name="Airedalefamilyconcensus" value="No">No<br>
</div>
<br><br>
<div class="style2">
Part 3: YARD</div>
<br><br>
<div height="60" class="style1">Do you have a fenced-in yard?:</div><br>
<div><input name="Fencedinyard" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">What kind of fence?:</div><br>
<div><input name="Kindoffence" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How high is the fence?:</div><br>
<div><input name="Howhighfence" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Size of fenced-in area?:</div><br>
<div><input name="Sizeoffencedinarea" type="text" class="mystyle" size="30" ></div>
<br><br>
<div height="60" class="style1">Does at least one door of the house open directly into the fenced in yard?:</div><br>
<div><input name="Onedoortofencedyard" type="text" class="mystyle" size="30" ></div>
<br><br>
<div height="60" class="style1">Do you have a swimming pool?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpool" value="No, we do not have a pool">No, we do not have a pool<br>
<input type="radio" name="Swimmingpool" value="Yes">Yes, in-ground<br>
<input type="radio" name="Swimmingpool" value="Yes">Yes, above ground<br>
</div>
<br><br>
<div height="60" class="style1">Is your pool separately fenced?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="Yes">Yes<br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="No">No<br>
<input type="radio" name="Swimmingpoolseparatelyfenced" value="NA">NA<br>
</div>
<br><br>
<div height="60" class="style1">Does your pool have "dog-proof" steps?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Swimmingpooldogproofsteps" value="Yes">Yes<br>
<input type="radio" name="Swimmingpooldogproofsteps" value="No">No<br>
<input type="radio" name="Swimmingpooldogproofsteps" value="NA">NA<br>
</div>
<br><br>
<div class="style2">
Part 4: AIREDALE PREFERENCES</div>
<br><br>
<div height="60" class="style1">Do you prefer a male or female?:<br>
Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Sex" value="Male"> Male <br>
<input type="radio" name="Sex" value="Female"> Female<br>
<input type="radio" name="Sex" value="No preference" checked="checked"> No Preference<br>
</div><br>
<div height="60" class="style1">Do you have an age preference?:</div><br>
<div class="mystyle"><br>
<input name="age" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Do you have a size preference?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Size" value="Under 60 pounds"> Under 60 pounds <br>
<input type="radio" name="Size" value="Over 60 pounds"> Over 60 pounds<br>
<input type="radio" name="Size" value="No preference" checked="checked"> No Preference<br>
</div><br>
<br>
<br>
<div height="60" class="style1">Would you consider an Airedale mix?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Airedalemix" value="Yes">Yes<br>
<input type="radio" name="Airedalemix" value="No">No<br>
</div>
<br><br>
<div class="style2">
Part 5: EXPERIENCE</div>
<br><br>
<div height="60" class="style1">Have you previously owned an <br>
Airedale?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Previouslyowned" value="Yes"> Yes <br>
<input type="radio" name="Previouslyowned" value="No" checked="checked"> No <br>
</div>
<br><br>
<div height="60" class="style1">When?:</div><br>
<div class="mystyle"><br>
<input name="Whenpreviouslyowned" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Male or Female?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Sexpreviouslyowned" value="Male"> Male <br>
<input type="radio" name="Sexpreviouslyowned" value="Female"> Female<br>
<input type="radio" name="Sexpreviouslyowned" value="Both"> Both<br>
<input type="radio" name="Sexpreviouslyowned" value="N/A" checked="checked"> N/A</div><br><br>
<div height="60" class="style1">What other dog breeds have <br>
you owned?:</div><br>
<div><input name="Otherbreeds" type="text" class="mystyle" size="30"></div>
<br>
<br>
<br>
<div height="60" class="style1">Do you own cats?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Cats" value="No">No<br>
<input type="radio" name="Cats" value="Yes, my cats are house pets">Yes, my cats are house pets<br>
<input type="radio" name="Cats" value="Yes, my cats are outdoor cats">Yes, my cats are outdoor cats<br>
<input type="radio" name="Cats" value="No, just strays">No, just strays<br>
</div>
<br><br>
<br>
<br>
<div height="60" class="style1">Are your cats compatible with dogs?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Catsdogs" value="Yes">Yes<br>
<input type="radio" name="Catsdogs" value="No">No<br>
<input type="radio" name="Catsdogs" value="NA">NA<br>
</div>
<br><br>
<br>
<br>
<div height="60" class="style1">What other pets do you currently
<br>have?:</div><br>
<div><input name="Otherpets" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Your pets ages:</div><br>
<div><input name="Otherpetsages" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are they spayed/neutered?:</div><br>
<div><input name="Otherpetsspayedneutered" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are your dogs currently licensed?:</div><br>
<div><input name="A" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">What happened to your last dog?:</div><br>
<div><input name="Fateoflasdivog" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Have you ever lost a dog other <br>
than through death?:</div><br>
<div><input name="Lostadog" type="text" class="mystyle" size="30">
</div>
<br><br>
<div height="60" class="style1">If you had to move, would you
<br>consider giving up your dog?:</div><br>
<div><input name="Movegiveupdog" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Has ownership of a dog ever caused you to be in a court situation?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Court" value="Yes">Yes<br>
<input type="radio" name="Court" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If so, how?:</div><br>
<div><input name="Courtifsohow" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are you ready for a dog now?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Readynow" value="Yes">Yes<br>
<input type="radio" name="Readynow" value="No">No<br>
</div>
<br><br>
<div height="60" class="style1">If not, what date did you have in mind?:</div><br>
<div><input name="Readynowifnowhen" type="text" class="mystyle" size="30"></div>
<br><br>
<div class="style2">
Part 6: LIVING WITH YOUR DOG</div>
<br><br>
<div height="60" class="style1">Will your new Airedale have
<br>"run of the house"?:</div><br>
<div class="mystyle"> <br>
<input type="radio" name="Runofhouse" value="Yes"> Yes
<br><input type="radio" name="Runofhouse" value="No" checked="checked"> No</div><br><br>
<div height="60" class="style1">Be allowed on the furniture?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Allowedonfurniture" value="Yes"> Yes <br>
<input type="radio" name="Allowedonfurniture" value="No" checked="checked"> No <br>
</div><br><br>
<div height="60" class="style1">
<p>Have his/her own dog bed and
<br>
blankets?:</div><br>
<div class="mystyle"><input type="radio" name="Havebedandblanket" value="Yes"> Yes <br>
<input type="radio" name="Havebedandblanket" value="No" checked="checked"> No <br><br>
</div>
<br><br>
<div height="60" class="style1">In what room will the dog bed be
<br>
placed?:</div><br>
<div><input name="Dogbedinwhatroom" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">In what room will your new
<br>Airedale sleep?:</div><br>
<div><input name="Wherewillairedalesleep" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How many hours at a time is no
<br>
one at home?:</div><br>
<div><input name="Hoursnoonehome" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">How many days a week will your
<br>
dog be left alone?:</div><br>
<div><input name="Daysaweekalone" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">In what room(s) will your dog be
<br>during the above times?:</div><br>
<div><input name="Whatroomabovetimes" type="text" class="mystyle" size="30">
</div>
<br><br>
<div height="60" class="style1">When you travel, where will your
<br>dog stay?:</div><br>
<div><input name="Travelingwherewilldogstay" type="text" class="mystyle" size="30"></div>
<br><br>
<div height="60" class="style1">Are you familiar with a dog crate?:</div><br>
<div class="mystyle"><br>
<input type="radio" name="Familiardogcrate" value="Yes">Yes</span> <br>
<input type="radio" name="Familiardogcrate" value="No" checked="checked">No</span></div><br><br>
<div height="80" class="style1">When do you use a crate?:</div><br>
<div><textarea name="whencrate" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div height="80" class="style1">In what room will you use a crate?:</div><br>
<div><textarea name="wherecrate" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 7: PERSONAL REFERENCES</div>
<br><br>
<div height="80" class="style1">REFERENCES: Name, address,
<br>
phone number:</div><br>
<div><textarea name="Reference1" cols="30" rows="4" class="mystyle"></textarea></div><br>
<br><br>
<div height="80" class="style1">REFERENCES: Name, address,
<br>
phone number:</div><br>
<div><textarea name="Reference2" cols="30" rows="4" class="mystyle"></textarea></div><br>
<br><br>
<div class="style2">
Part 8: VETERINARIAN REFERENCE</div>
<br><br>
<div height="80" class="style1">Veterinarian's name, address,
<br>phone number:</div><br>
<div><textarea name="Vetinfo" cols="30" rows="4" class="mystyle"></textarea></div>
<br><br>
<div class="style2">
Part 9: COMMENTS</div>
<br><br>
<div height="60" class="style1">Comments:</div><br>
<div><textarea name="Comments" cols="30" rows="8" class="mystyle"></textarea></div>
<br><br>
<!-- This section is the web form that creates the data-->
<div><input type="submit" name="Submit" value="Submit" onClick="validate();return returnVal;" value="Test fields"></div>
</form>
</body>
</html>