specific areas of concern/advice
declare posted variables of which there are 20-50 depending on the form
manor in which i execute my sql queries
Thanks for any suggestions - I am much appreciative
Adreck
note - i have 3 total switch cases, but I only show you 1 because it was over the character max for this window. I am displaying the crux of my questions I think I can translate the rest myself. Thanks
Code: Select all
<?php
// Application Processor for Test Company
// Receive a series of POST data from a form
if ($_POST)
{
//If the data has been posted connect to connect.php
//Connect to mysql database
require_once(connect.php);
//Declare Security function
//When called encrypt using MCYRPT
function F93e359d5($V897d85dc) {
$V3cf118b8 = mcrypt_get_iv_size(MCRYPT_RIJNDAEL_256, MCRYPT_MODE_ECB);
$V9961a139 = mcrypt_create_iv($V3cf118b8, MCRYPT_RAND);
$V20e081e0 = $V441333ea;
$Ve88d3782 = mcrypt_encrypt(MCRYPT_RIJNDAEL_256, $V20e081e0, $V897d85dc, MCRYPT_MODE_ECB, $V9961a139);
return $Ve88d3782; }
$V062dd8d3 = array_keys($_POST['submit']);
$V418c5509 = $V062dd8d3[0];
//Based on the name of the submit button execute respective case
switch ($V418c5509)
{ case 'submit':
// Case submit has been initiated post form variables
// Prepare posted variables for encryption and safe entry to MYSQL
$V441333ea = mysql_real_escape_string(F93e359d5($_POST['V441333ea']));
$Vb881b5d1 = mysql_real_escape_string(F93e359d5($_POST['Vb881b5d1']));
$V920cd768 = mysql_real_escape_string(F93e359d5($_POST['V920cd768']));
$V170289cc = mysql_real_escape_string(F93e359d5($_POST['V170289cc']));
$V8cdfc4ad = mysql_real_escape_string(F93e359d5($_POST['V8cdfc4ad']));
$Va1c0936b = mysql_real_escape_string(F93e359d5($_POST['Va1c0936b']));
$Vabaf4b9d = mysql_real_escape_string(F93e359d5($_POST['Vabaf4b9d']));
$Vf57719e2 = mysql_real_escape_string(F93e359d5($_POST['Vf57719e2']));
$V487f4342 = mysql_real_escape_string(F93e359d5($_POST['V487f4342']));
$V02b0eccc = mysql_real_escape_string(F93e359d5($_POST['V02b0eccc']));
$V3deb1883 = mysql_real_escape_string(F93e359d5($_POST['V3deb1883']));
$Vcdbeaf04= mysql_real_escape_string(F93e359d5($_POST['Vcdbeaf04']));
$V2eb0ab94= mysql_real_escape_string(F93e359d5($_POST['V2eb0ab94']));
$V9c37433b= mysql_real_escape_string(F93e359d5($_POST['V9c37433b']));
$Vc8a2fda2= mysql_real_escape_string(F93e359d5($_POST['Vc8a2fda2']));
$V9155b622 =mysql_real_escape_string(F93e359d5($_POST['V9155b622']));
$V027940a9= mysql_real_escape_string(F93e359d5($_POST['V027940a9']));
$Va12f82c5= mysql_real_escape_string(F93e359d5($_POST['Va12f82c5']));
$V34027e92= mysql_real_escape_string(F93e359d5($_POST['V34027e92']));
$V39f304b4= mysql_real_escape_string(F93e359d5($_POST['V39f304b4']));
$V8a205fc1= mysql_real_escape_string(F93e359d5($_POST['V8a205fc1']));
$V2b52c37e= mysql_real_escape_string(F93e359d5($_POST['V2b52c37e']));
$V89700e4b= mysql_real_escape_string(F93e359d5($_POST['V89700e4b']));
$V934bc223= mysql_real_escape_string(F93e359d5($_POST['V934bc223']));
$V265a9e70= mysql_real_escape_string(F93e359d5($_POST['V265a9e70']));
$V3eb4d912= mysql_real_escape_string(F93e359d5($_POST['V3eb4d912']));
$V8db6ad6d= mysql_real_escape_string(F93e359d5($_POST['V8db6ad6d']));
$Vca4fa21a= mysql_real_escape_string(F93e359d5($_POST['Vca4fa21a']));
$Vcf94462c= mysql_real_escape_string(F93e359d5($_POST['Vcf94462c']));
$Vc9e391cb= mysql_real_escape_string(F93e359d5($_POST['Vc9e391cb']));
$Va5cfd170= mysql_real_escape_string(F93e359d5($_POST['Va5cfd170']));
$Vab34db38= mysql_real_escape_string(F93e359d5($_POST['Vab34db38']));
$V36383ef3= mysql_real_escape_string(F93e359d5($_POST['V36383ef3']));
$V253cb2aa= mysql_real_escape_string(F93e359d5($_POST['V253cb2aa']));
$V14d30ea0=mysql_real_escape_string(F93e359d5($_POST['V14d30ea0']));
$V2fce4775= mysql_real_escape_string(F93e359d5($_POST['V2fce4775']));
$V587880a0= mysql_real_escape_string(F93e359d5($_POST['V587880a0']));
$Vd3155f32= mysql_real_escape_string(F93e359d5($_POST['Vd3155f32']));
$V5a5ba599= mysql_real_escape_string(F93e359d5($_POST['V5a5ba599']));
$Va93704f7= mysql_real_escape_string(F93e359d5($_POST['Va93704f7']));
$V5e72a50d= mysql_real_escape_string(F93e359d5($_POST['V5e72a50d']));
$V78bc472f= mysql_real_escape_string(F93e359d5($_POST['V78bc472f']));
$V4a4bd6cb= mysql_real_escape_string(F93e359d5($_POST['V4a4bd6cb']));
$Vf10e580d= mysql_real_escape_string(F93e359d5($_POST['Vf10e580d']));
$Vad90160e= mysql_real_escape_string(F93e359d5($_POST['Vad90160e']));
$V2645f6a3= mysql_real_escape_string(F93e359d5($_POST['V2645f6a3']));
$V222a4f77=mysql_real_escape_string(F93e359d5($_POST['V222a4f77']));
$V9700bb59= mysql_real_escape_string(F93e359d5($_POST['V9700bb59']));
$Ve926bd5b= mysql_real_escape_string(F93e359d5($_POST['Ve926bd5b']));
$V1a967bca= mysql_real_escape_string(F93e359d5($_POST['V1a967bca']));
$V5cca3df0= mysql_real_escape_string(F93e359d5($_POST['V5cca3df0']));
$V5fe8848a= mysql_real_escape_string(F93e359d5($_POST['V5fe8848a']));
$V8a8da429= mysql_real_escape_string(F93e359d5($_POST['V8a8da429']));
$Vb121cafb=mysql_real_escape_string(F93e359d5($_POST['Vb121cafb']));
$V5e8d73e5= mysql_real_escape_string(F93e359d5($_POST['V5e8d73e5']));
$Vb2217207= mysql_real_escape_string(F93e359d5($_POST['Vb2217207']));
$V1c7838a2= mysql_real_escape_string(F93e359d5($_POST['V1c7838a2']));
$V348bf10a= mysql_real_escape_string(F93e359d5($_POST['V348bf10a']));
$V80ae0961= mysql_real_escape_string(F93e359d5($_POST['V80ae0961']));
$V7a6fcdd3= mysql_real_escape_string(F93e359d5($_POST['V7a6fcdd3']));
$V30343ac4=mysql_real_escape_string(F93e359d5($_POST['V30343ac4']));
$Vfa80dad2= mysql_real_escape_string(F93e359d5($_POST['Vfa80dad2']));
$V948beb07= mysql_real_escape_string(F93e359d5($_POST['V948beb07']));
$Vf820281f= mysql_real_escape_string(F93e359d5($_POST['Vf820281f']));
$Vfb7ec4ca= mysql_real_escape_string(F93e359d5($_POST['Vfb7ec4ca']));
$Ve674ef52= mysql_real_escape_string(F93e359d5($_POST['Ve674ef52']));
$Vd80e2a19= mysql_real_escape_string(F93e359d5($_POST['Vd80e2a19']));
$Vcefc3063=mysql_real_escape_string(F93e359d5($_POST['Vcefc3063']));
$V665bbecd= mysql_real_escape_string(F93e359d5($_POST['V665bbecd']));
$Va835b570= mysql_real_escape_string(F93e359d5($_POST['Va835b570']));
$V0e7a2142= mysql_real_escape_string(F93e359d5($_POST['V0e7a2142']));
$V810fdedc= mysql_real_escape_string(F93e359d5($_POST['V810fdedc']));
$Va79af0f8= mysql_real_escape_string(F93e359d5($_POST['Va79af0f8']));
$Vdb42bac1= mysql_real_escape_string(F93e359d5($_POST['Vdb42bac1']));
$V3680ac51=mysql_real_escape_string(F93e359d5($_POST['V3680ac51']));
$Vac0e306d= mysql_real_escape_string(F93e359d5($_POST['Vac0e306d']));
$Vdf44330b= mysql_real_escape_string(F93e359d5($_POST['Vdf44330b']));
$Vf68fc1b9= mysql_real_escape_string(F93e359d5($_POST['Vf68fc1b9']));
$V8d6c10d8= mysql_real_escape_string(F93e359d5($_POST['V8d6c10d8']));
$Ve92d92b6= mysql_real_escape_string(F93e359d5($_POST['Ve92d92b6']));
$V37869aaf= mysql_real_escape_string(F93e359d5($_POST['V37869aaf']));
$V3f152844=mysql_real_escape_string(F93e359d5($_POST['V3f152844']));
$V71c4ca85= mysql_real_escape_string(F93e359d5($_POST['V71c4ca85']));
$Vfa7b1591= mysql_real_escape_string(F93e359d5($_POST['Vfa7b1591']));
$Vc8b8fc0b= mysql_real_escape_string(F93e359d5($_POST['Vc8b8fc0b']));
$V78d35f25= mysql_real_escape_string(F93e359d5($_POST['V78d35f25']));
$V8f1cfaa5= mysql_real_escape_string(F93e359d5($_POST['V8f1cfaa5']));
$Vf19b7a98= mysql_real_escape_string(F93e359d5($_POST['Vf19b7a98']));
$Vdf0883be=mysql_real_escape_string(F93e359d5($_POST['Vdf0883be']));
$Va955ee19= mysql_real_escape_string(F93e359d5($_POST['Va955ee19']));
$V626fa029= mysql_real_escape_string(F93e359d5($_POST['V626fa029']));
$V9254ac4d= mysql_real_escape_string(F93e359d5($_POST['V9254ac4d']));
$V8f9f0583= mysql_real_escape_string(F93e359d5($_POST['V8f9f0583']));
$V3b5559cb= mysql_real_escape_string(F93e359d5($_POST['V3b5559cb']));
$V508765c3= mysql_real_escape_string(F93e359d5($_POST['V508765c3']));
$Ve61c3935=mysql_real_escape_string(F93e359d5($_POST['Ve61c3935']));
$V79ebc28b= mysql_real_escape_string(F93e359d5($_POST['V79ebc28b']));
$V62c975e0= mysql_real_escape_string(F93e359d5($_POST['V62c975e0']));
$V8d6efbdb= mysql_real_escape_string(F93e359d5($_POST['V8d6efbdb']));
$V86145225= mysql_real_escape_string(F93e359d5($_POST['V86145225']));
$V35224ea0= mysql_real_escape_string(F93e359d5($_POST['V35224ea0']));
$V2d2c7097= mysql_real_escape_string(F93e359d5($_POST['V2d2c7097']));
$V05c5b713=mysql_real_escape_string(F93e359d5($_POST['V05c5b713']));
$Vc2ad2c27= mysql_real_escape_string(F93e359d5($_POST['Vc2ad2c27']));
$Vd263457a= mysql_real_escape_string(F93e359d5($_POST['Vd263457a']));
$V55bad94c= mysql_real_escape_string(F93e359d5($_POST['V55bad94c']));
$Va826e6f2= mysql_real_escape_string(F93e359d5($_POST['Va826e6f2']));
$V8076ae0c= mysql_real_escape_string(F93e359d5($_POST['V8076ae0c']));
$V2f875f74= mysql_real_escape_string(F93e359d5($_POST['V2f875f74']));
$Vb4cdbd0e=mysql_real_escape_string(F93e359d5($_POST['Vb4cdbd0e']));
$Vb636ede0= mysql_real_escape_string(F93e359d5($_POST['Vb636ede0']));
$V19a45eea= mysql_real_escape_string(F93e359d5($_POST['V19a45eea']));
$V81fd48da= mysql_real_escape_string(F93e359d5($_POST['V81fd48da']));
$V3ec1796a= mysql_real_escape_string(F93e359d5($_POST['V3ec1796a']));
$Va59b4a0e= mysql_real_escape_string(F93e359d5($_POST['Va59b4a0e']));
$V23ccd8ea= mysql_real_escape_string(F93e359d5($_POST['V23ccd8ea']));
$V67f860df=mysql_real_escape_string(F93e359d5($_POST['V67f860df']));
$V83c0d6e4= mysql_real_escape_string(F93e359d5($_POST['V83c0d6e4']));
$Vd2ab21c4= mysql_real_escape_string(F93e359d5($_POST['Vd2ab21c4']));
$V194efb5c= mysql_real_escape_string(F93e359d5($_POST['V194efb5c']));
$Ve14b8e40= mysql_real_escape_string(F93e359d5($_POST['Ve14b8e40']));
$V6c0c9e85= mysql_real_escape_string(F93e359d5($_POST['V6c0c9e85']));
$V7809c15c= mysql_real_escape_string(F93e359d5($_POST['V7809c15c']));
$V06fded17=mysql_real_escape_string(F93e359d5($_POST['V06fded17']));
$V432847bb= mysql_real_escape_string(F93e359d5($_POST['V432847bb']));
$V08ba5d24= mysql_real_escape_string(F93e359d5($_POST['V08ba5d24']));
$V284a8d20= mysql_real_escape_string(F93e359d5($_POST['V284a8d20']));
$V1eac6bb7= mysql_real_escape_string(F93e359d5($_POST['V1eac6bb7']));
$V7356b152= mysql_real_escape_string(F93e359d5($_POST['V7356b152']));
$V03f1cd3a= mysql_real_escape_string(F93e359d5($_POST['V03f1cd3a']));
$V1358abf8=mysql_real_escape_string(F93e359d5($_POST['V1358abf8']));
$V8e462a87= mysql_real_escape_string(F93e359d5($_POST['V8e462a87']));
$V81c1b5dc= mysql_real_escape_string(F93e359d5($_POST['V81c1b5dc']));
$V1f311062= mysql_real_escape_string(F93e359d5($_POST['V1f311062']));
$V561e5cb9= mysql_real_escape_string(F93e359d5($_POST['V561e5cb9']));
$Vdb7819ae= mysql_real_escape_string(F93e359d5($_POST['Vdb7819ae']));
$V8b86a40a= mysql_real_escape_string(F93e359d5($_POST['V8b86a40a']));
$V4bd65c97=mysql_real_escape_string(F93e359d5($_POST['V4bd65c97']));
$V430c2f5f= mysql_real_escape_string(F93e359d5($_POST['V430c2f5f']));
$Ved3fc6a3= mysql_real_escape_string(F93e359d5($_POST['Ved3fc6a3']));
$V05a9d7ae= mysql_real_escape_string(F93e359d5($_POST['V05a9d7ae']));
$V29e5f093= mysql_real_escape_string(F93e359d5($_POST['V29e5f093']));
$Vb628326b= mysql_real_escape_string(F93e359d5($_POST['Vb628326b']));
$V3e376d73= mysql_real_escape_string(F93e359d5($_POST['V3e376d73']));
$Vf84d2ab3=mysql_real_escape_string(F93e359d5($_POST['Vf84d2ab3']));
$V165dae04= mysql_real_escape_string(F93e359d5($_POST['V165dae04']));
$V3efe72db= mysql_real_escape_string(F93e359d5($_POST['V3efe72db']));
$V13663383= mysql_real_escape_string(F93e359d5($_POST['V13663383']));
$V2422c4dd= mysql_real_escape_string(F93e359d5($_POST['V2422c4dd']));
$V40d924a0= mysql_real_escape_string(F93e359d5($_POST['V40d924a0']));
$Ve3a31a6c= mysql_real_escape_string(F93e359d5($_POST['Ve3a31a6c']));
$V189049ca=mysql_real_escape_string(F93e359d5($_POST['V189049ca']));
$Vdb1823a1= mysql_real_escape_string(F93e359d5($_POST['Vdb1823a1']));
//Save Page data html in variable $V71860c77
//Page data will display posted data in a form for user verification
//NOTE Need to either not encrypt or decrypt prior to post next edit
$V71860c77 = '<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<title>Secure Brokerage Account Application | Test Company, LLC</title>
<link href="css/appform.css" rel="stylesheet" type="text/css" />
<link href="css/app.css" rel="stylesheet" type="text/css" />
<link href="css/app_global.css" rel="stylesheet" type="text/css" />
</head>
<body class="appStyle">
<div id="container"><div id="header"><div id="p1">
<div id="title"><strong>Test Company LLC </strong>- Brokerage Account Application - Review & Submit</div>
<div id="p3"></div></div>
</div>
<p></p>
<div id="content"><div id="p1"><div id="p2"></div>
<div id="question">
<div id="instruct"><h4>Congratulations!</h4>
<p> '.$Vb881b5d1.' '.$V920cd768.' - You are about to submit your completed application to Test Company, LLC. If you notice any errors, please correct them now. You are currently using tracking id: <b>'.$V441333ea.'</b>. If this or any other information is incorrect please make the necessary changes now. Thank You!
</div>
<form action="appProcess55.php" method="post">
<fieldset>
<legend>New Account - Brokerage Account Application</legend>
<p><div id="cbox">
<label>(For Married Persons | Retired)</label>
</div><br /><p>
<div id="lbox"><label for="pwd">Your Tracking ID is:</label></div>
<input class="formInputText" type="text" name="V441333ea" id="pwd" size="40" value="'.$V441333ea.'" maxlength="24" tabindex="1" />
<br />
<br />
<div id="lbox">
<label for="fname">Full Name:</label>
</div>
<input name="Vb881b5d1" type="text" class="formInputText" id="fname" tabindex="2" value="'.$Vb881b5d1.'" size="18" maxlength="24" />
<input name="V920cd768" type="text" class="formInputText" id="lname" tabindex="3" value="'.$V920cd768.'" size="18" maxlength="24" />
<br/>
<div id="lbox"><label for="ssn">SSN:</label></div>
<input name="V170289cc" type="text" class="formInputText" id="ssn" tabindex="4" value="'.$V170289cc.'" size="40" maxlength="9" />
<br/>
<div id="lbox"><label for="email">E-mail:</label></div>
<input name="V8cdfc4ad" type="text" class="formInputText" id="email" tabindex="5" value="'.$V8cdfc4ad.'" size="40" maxlength="50" />
<br/>
<div id="lbox"><label for="addr">Address:</label></div>
<input class="formInputText" type="text" name="Va1c0936b" id="addr" size="40" value="'.$Va1c0936b.'" maxlength="30" tabindex="6" />
<br />
<div id="lbox">
<label for="addr">City/State:</label>
</div>
<input class="formInputText" type="text" name="Vabaf4b9d" id="city" size="18" value="'.$Vabaf4b9d.'" maxlength="30" tabindex="7"/>
<input class="formInputText" type="text" name="Vf57719e2" id="state" size="18" value="'.$Vf57719e2.'" maxlength="30" tabindex="8"/>
<br/>
<div id="lbox"><label>Zip-Code:</label></div>
<input class="formInputText" type="text" name="V487f4342" id="zip" size="10" value="'.$V487f4342.'" maxlength="24" tabindex="9" />
<br />
<br/>
<div id="lbox"><label for="hphone">Phone(s):</label></div>
<input class="formInputText" type="text" name="V02b0eccc" id="hphone" size="18" value="'.$V02b0eccc.'" maxlength="12" tabindex="10" />
<input class="formInputText" type="text" name="V5738e999" id="wphone" size="18" value="'.$V5738e999.'" maxlength="24" tabindex="11" />
<br/>
<div id="lbox">
<label for="dob">Birthday:</label>
</div>
<input name="V3deb1883" type="text" class="formInputText" id="dob" tabindex="12" value="'.$V3deb1883.'" size="18" maxlength="24"/>
<input name="Vcdbeaf04" type="text" class="formInputText" id="pbirth" tabindex="13" value="'.$Vcdbeaf04.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="estat">Employment :</label>
</div>
<input name="V2eb0ab94" type="text" class="formInputText" id="estat" tabindex="14" value="'.$V2eb0ab94.'" size="18" maxlength="40" />
<input name="Va12f82c5" type="text" class="formInputText" id="occup" tabindex="15" value="'.$Va12f82c5.'" size="18" maxlength="40" />
<br/>
<div id="lbox"><label for="ename">Name of Employer:</label></div>
<input name="V9c37433b" type="text" class="formInputText" id="ename" tabindex="16" value="'.$V9c37433b.'" size="40" maxlength="40" />
<br/>
<div id="lbox"><label for="eaddr">Employer Address:</label></div>
<input name="Vc8a2fda2" type="text" class="formInputText" id="eaddr" tabindex="17" value="'.$Vc8a2fda2.'" size="40" maxlength="50" />
<br/>
<div id="lbox">
<label for="mstat">Family Information:</label>
</div>
<input name="V9155b622" type="text" class="formInputText" id="mstat" tabindex="18" value="'.$V9155b622.'" size="18" maxlength="40" />
<input name="V027940a9" type="text" class="formInputText" id="dpnd" tabindex="19" value="'.$V027940a9.'" size="18" maxlength="40" />
<br/>
<div id="lbox"><label for="dlic">Drivers License</label>
</div>
<input name="V34027e92" type="text" class="formInputText" id="dlic" tabindex="20" value="'.$V34027e92.'" size="40" maxlength="40" />
<br/>
<div id="lbox">
<label for="sdstate">License State</label>
</div>
<input class="formInputText" type="text" name="V587880a0" id="sdstate" size="18" value="'.$V39f304b4.'" maxlength="30" tabindex="21"/>
<br/><br />
<div id="lbox">
<label for="dlic">Do you want check writing on this account?:</label>
</div>
<input class="formInputText" type="text" name="V8a205fc1" id="cwtg" size="18" value="'.$V8a205fc1.'" maxlength="30" tabindex="22"/>
<p><br />
<br />
<hr align="center" width="620" />
<div id="lbox">
<label for="fname">Financial Information</label>
</div><p><br />
<div id="lbox">
<label for="bank">Name of Bank:</label>
</div>
<input name="Vd3155f32" type="text" class="formInputText" id="bank" tabindex="41" value="'.$Vd3155f32.'" size="40" maxlength="50" />
<br/>
<div id="lbox">
<label for="accNum">Account Number:</label>
</div>
<input name="V5a5ba599" type="text" class="formInputText" id="accNum" value="'.$V5a5ba599.'" tabindex="42" size="40" maxlength="50" />
<br/>
<div id="lbox">
<label for="eaddr">Bank Address:</label>
</div>
<input name="Va93704f7" type="text" class="formInputText" id="baddr" tabindex="43" value="'.$Va93704f7.'" size="40" maxlength="50" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="eaddr">Estimated Annual Income</label>
</div><input class="formInputText" type="text" name="V5e72a50d" id="eai" size="18" value="'.$V5e72a50d.'" maxlength="30" tabindex="44"/>
<p><br />
<hr align="center" width="550" />
<div id="suppInfo">
<div align="center"><b>Supplment Application for Retirement Accounts<br />
Your Application Data</b><br />
</div>
</div>
<p><br />
<br />
<br />
<!--Begin Now - Supplement for Retirement Accounts --></p>
<div id="retireInfo">
<div align="center">Your Primary Beneficiaries<br />
<span class="style1 style2">(For IRAs and other retirement accounts)</span></div>
</div>
<p><br />
<br />
<br />
<br />
</p>
<div id="lbox">
<label for="sectionHeader">1) Beneficiary</label>
</div><p><br />
<div id="lbox">
<label for="bfy2Nam">Full Name:</label>
</div>
<input name="V78bc472f" type="text" class="formInputText" id="bfy1Nam" tabindex="24" value="'.$V78bc472f.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfy2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="V4a4bd6cb" id="bfy1Addr" size="40" value="'.$V4a4bd6cb.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfy2Addr">Date of Birth:</label>
</div>
<input name="Vf10e580d" type="text" class="formInputText" id="bfy1DOB" tabindex="33" onFocus="F15d68166(this)" value="'.$Vf10e580d.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfy2SSN">SSN:</label>
</div>
<input name="Vad90160e" type="text" class="formInputText" id="bfy1SSN" tabindex="26" onFocus="F15d68166(this)" value="'.$Vad90160e.'" size="18" maxlength="9" vale="'.$V5e72a50d.'" />
<br/>
<div id="lbox">
<label for="bfy2Rel">Relationship:</label>
</div>
<input name="V2645f6a3" type="text" class="formInputText" id="bfy1Rel" tabindex="27" onFocus="F15d68166(this)" value="'.$V2645f6a3.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfy2Phon">Phone:</label>
</div>
<input name="V222a4f77" type="text" class="formInputText" id="bfy1Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$V222a4f77.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfy2DOB">Share:</label>
</div>
<input name="V9700bb59" type="text" class="formInputText" id="bfy1Share" tabindex="34" onFocus="F15d68166(this)" value="'.$V9700bb59.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">2) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfy2Nam">Full Name:</label>
</div>
<input name="Ve926bd5b" type="text" class="formInputText" id="bfy2Nam" tabindex="24"value="'.$Ve926bd5b.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfy2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="V1a967bca" id="bfy2Addr" size="40"value="'.$V1a967bca.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfy2Addr">Date of Birth:</label>
</div>
<input name="V5cca3df0" type="text" class="formInputText" id="bfy2DOB" tabindex="33" onFocus="F15d68166(this)"value="'.$V5cca3df0.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfy2SSN">SSN:</label>
</div>
<input name="V5fe8848a" type="text" class="formInputText" id="bfy2SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$V5fe8848a.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfy2Rel">Relationship:</label>
</div>
<input name="V8a8da429" type="text" class="formInputText" id="bfy2Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$V8a8da429.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfy2Phon">Phone:</label>
</div>
<input name="Vb121cafb" type="text" class="formInputText" id="bfy2Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$Vb121cafb.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfy2DOB">Share:</label>
</div>
<input name="V5e8d73e5" type="text" class="formInputText" id="bfy2Share" tabindex="34" onFocus="F15d68166(this)"value="'.$V5e8d73e5.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">3) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfy2Nam">Full Name:</label>
</div>
<input name="Vb2217207" type="text" class="formInputText" id="bfy3Nam" tabindex="24"value="'.$Vb2217207.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfy2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="V1c7838a2" id="bfy3Addr" size="40"value="'.$V1c7838a2.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfy2Addr">Date of Birth:</label>
</div>
<input name="V348bf10a" type="text" class="formInputText" id="bfy3DOB" tabindex="33" onFocus="F15d68166(this)"value="'.$V348bf10a.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfy2SSN">SSN:</label>
</div>
<input name="V80ae0961" type="text" class="formInputText" id="bfy3SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$V80ae0961.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfy2Rel">Relationship:</label>
</div>
<input name="V7a6fcdd3" type="text" class="formInputText" id="bfy3Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$V7a6fcdd3.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfy2Phon">Phone:</label>
</div>
<input name="V30343ac4" type="text" class="formInputText" id="bfy3Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$V30343ac4.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfy2DOB">Share:</label>
</div>
<input name="Vfa80dad2" type="text" class="formInputText" id="bfy3Share" tabindex="34" onFocus="F15d68166(this)"value="'.$Vfa80dad2.'" size="18" maxlength="40" />
<br/><hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">4) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfy2Nam">Full Name:</label>
</div>
<input name="V948beb07" type="text" class="formInputText" id="bfy4Nam" tabindex="24"value="'.$V948beb07.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfy2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="Vf820281f" id="bfy4Addr" value="'.$Vf820281f.'" size="40" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfy2Addr">Date of Birth:</label>
</div>
<input name="Vfb7ec4ca" type="text" class="formInputText" id="bfy4DOB" tabindex="33" onFocus="F15d68166(this)" value="'.$Vfb7ec4ca.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfy2SSN">SSN:</label>
</div>
<input name="Ve674ef52" type="text" class="formInputText" id="bfy4SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$Ve674ef52.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfy2Rel">Relationship:</label>
</div>
<input name="Vd80e2a19" type="text" class="formInputText" id="bfy4Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$Vd80e2a19.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfy2Phon">Phone:</label>
</div>
<input name="Vcefc3063" type="text" class="formInputText" id="bfy4Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$Vcefc3063.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfy2DOB">Share:</label>
</div>
<input name="V665bbecd" type="text" class="formInputText" id="bfy4Share" tabindex="34" onFocus="F15d68166(this)"value="'.$V665bbecd.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="620" />
<div id="retireInfo">
<div align="center">Your Contingent Beneficiaries<br />
<span class="style1 style2">(For IRAs and other retirement accounts)</span></div>
</div>
<p><br />
<br />
<!--Begin Now - Supplement for Retirement Accounts --></p>
<p><br />
<div id="lbox">
<label for="sectionHeader">1) Beneficiary</label>
</div><p><br />
<br />
<div id="lbox">
<label for="SbfyC2Nam">Full Name:</label></div>
<input name="Va835b570" type="text" class="formInputText" id="bfyC1Nam" tabindex="24" value="'.$Va835b570.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfyC2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="V0e7a2142" id="bfyC1Addr" size="40" value="'.$V0e7a2142.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfyC2Addr">Date of Birth:</label>
</div>
<input name="V810fdedc" type="text" class="formInputText" id="bfyC1DOB" tabindex="33" onFocus="F15d68166(this)" value="'.$V810fdedc.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfyC2SSN">SSN:</label>
</div>
<input name="Va79af0f8" type="text" class="formInputText" id="bfyC1SSN" tabindex="26" onFocus="F15d68166(this)" value="'.$Va79af0f8.'" size="18" maxlength="9" vale="'.$V5e72a50d.'" />
<br/>
<div id="lbox">
<label for="bfyC2Rel">Relationship:</label>
</div>
<input name="Vdb42bac1" type="text" class="formInputText" id="bfyC1Rel" tabindex="27" onFocus="F15d68166(this)" value="'.$Vdb42bac1.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfyC2Phon">Phone:</label>
</div>
<input name="V3680ac51" type="text" class="formInputText" id="bfyC1Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$V3680ac51.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfyC2DOB">Share:</label>
</div>
<input name="Vac0e306d" type="text" class="formInputText" id="bfyC1Share" tabindex="34" onFocus="F15d68166(this)" value="'.$Vac0e306d.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">2) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfyC2Nam">Full Name:</label>
</div>
<input name="Vdf44330b" type="text" class="formInputText" id="bfyC2Nam" tabindex="24"value="'.$Vdf44330b.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfyC2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="Vf68fc1b9" id="bfyC2Addr" size="40"value="'.$Vf68fc1b9.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfyC2Addr">Date of Birth:</label>
</div>
<input name="V8d6c10d8" type="text" class="formInputText" id="bfyC2DOB" tabindex="33" onFocus="F15d68166(this)"value="'.$V8d6c10d8.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfyC2SSN">SSN:</label>
</div>
<input name="Ve92d92b6" type="text" class="formInputText" id="bfyC2SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$Ve92d92b6.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfyC2Rel">Relationship:</label>
</div>
<input name="V37869aaf" type="text" class="formInputText" id="bfyC2Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$V37869aaf.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfyC2Phon">Phone:</label>
</div>
<input name="V3f152844" type="text" class="formInputText" id="bfyC2Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$V3f152844.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfyC2DOB">Share:</label>
</div>
<input name="V71c4ca85" type="text" class="formInputText" id="bfyC2Share" tabindex="34" onFocus="F15d68166(this)"value="'.$V71c4ca85.'" size="18" maxlength="40" />
<br/>
<hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">3) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfyC2Nam">Full Name:</label>
</div>
<input name="Vfa7b1591" type="text" class="formInputText" id="bfyC3Nam" tabindex="24"value="'.$Vfa7b1591.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfyC2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="Vc8b8fc0b" id="bfyC3Addr" size="40"value="'.$Vc8b8fc0b.'" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfyC2Addr">Date of Birth:</label>
</div>
<input name="V78d35f25" type="text" class="formInputText" id="bfyC3DOB" tabindex="33" onFocus="F15d68166(this)"value="'.$V78d35f25.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfyC2SSN">SSN:</label>
</div>
<input name="V8f1cfaa5" type="text" class="formInputText" id="bfyC3SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$V8f1cfaa5.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfyC2Rel">Relationship:</label>
</div>
<input name="Vf19b7a98" type="text" class="formInputText" id="bfyC3Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$Vf19b7a98.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfyC2Phon">Phone:</label>
</div>
<input name="Vdf0883be" type="text" class="formInputText" id="bfyC3Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$Vdf0883be.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfyC2DOB">Share:</label>
</div>
<input name="Va955ee19" type="text" class="formInputText" id="bfyC3Share" tabindex="34" onFocus="F15d68166(this)"value="'.$Va955ee19.'" size="18" maxlength="40" />
<br/><hr align="center" width="550" />
<div id="lbox">
<label for="sectionHeader">4) Beneficiary</label>
</div>
<p><br />
<div id="lbox">
<label for="bfyC2Nam">Full Name:</label>
</div>
<input name="V626fa029" type="text" class="formInputText" id="bfyC4Nam" tabindex="24"value="'.$V626fa029.'" size="40" maxlength="24" onFocus="F15d68166(this)"/>
<br/>
<div id="lbox"><label for="bfyC2Addr">Address:</label>
</div>
<input class="formInputText" type="text" name="V9254ac4d" id="bfyC4Addr" value="'.$V9254ac4d.'" size="40" maxlength="50" tabindex="30" onFocus="F15d68166(this)" />
<br />
<div id="lbox">
<label for="bfyC2Addr">Date of Birth:</label>
</div>
<input name="V8f9f0583" type="text" class="formInputText" id="bfyC4DOB" tabindex="33" onFocus="F15d68166(this)" value="'.$V8f9f0583.'" size="18" maxlength="24"/>
<br />
<div id="lbox"><label for="bfyC2SSN">SSN:</label>
</div>
<input name="V3b5559cb" type="text" class="formInputText" id="bfyC4SSN" tabindex="26" onFocus="F15d68166(this)"value="'.$V3b5559cb.'" size="18" maxlength="9" />
<br/>
<div id="lbox">
<label for="bfyC2Rel">Relationship:</label>
</div>
<input name="V508765c3" type="text" class="formInputText" id="bfyC4Rel" tabindex="27" onFocus="F15d68166(this)"value="'.$V508765c3.'" size="40" maxlength="V795b93ef" />
<br/>
<br/>
<div id="lbox">
<label for="bfyC2Phon">Phone:</label>
</div>
<input name="Ve61c3935" type="text" class="formInputText" id="bfyC4Phon" tabindex="31" onFocus="F15d68166(this)"value="'.$Ve61c3935.'" size="18" maxlength="12" />
<br/>
<div id="lbox">
<label for="bfyC2DOB">Share:</label>
</div>
<input name="V79ebc28b" type="text" class="formInputText" id="bfyC4Share" tabindex="34" onFocus="F15d68166(this)"value="'.$V79ebc28b.'" size="18" maxlength="40" />
<br />
<br />
<br />
</p>
<div style="clear:both;">
<label> </label>
<input class="formInputButton" type="submit" name="submit[enter]"
value="Save & Edit Later">
</div>
</fieldset><br />
</form>
</div>
<div id="p3"></div></div>
<div id="footer">©2008 <a href="http://www.TestCompanyllc.com">TestCompanyLLC.com</a> - Test Company, LLC </div>
</div
></div>
</body>
</html>
';
// echo shows html mark up for page/form
// print posted data on page for user verification
echo $V71860c77;
break;
mysql_close($V4717d53e);
}
?>