Contact form

<?php
$website_logo = 'http://'.$_SERVER['SERVER_NAME'].'/favicon.ico'; // если не иконки, тогда указать вручную полный путь на /favicon.ico. Пример: "http://ваш_сайт/favicon.ico"
// Настройки - какие поля отображать //
// 0 - disable;  1 - enable;
$FirstName = 1;
$Surname = 1;
$Gender = 1;
$Age = 1;
$MobilePhoneNumber = 1;
$AreaCode = 1;
$PhoneNumber = 1;
$Address = 1;
$State = 1;
$Country = 1;
$PostCode = 1;
?>
<!-- // Стили можно вынести в отдельный файл "style.css" и подключить <link href="/style.css" rel="stylesheet" type="text/css" /> //-->
<style>
.website_logo {
left: 15px;
top: 13px;
width: 32px;
position: absolute
}
.cont_form_head {
width:400px;
text-align:left;
border:1px solid #CCCCCC;
color:#003300;
font:14px tahoma, verdana;
background:#F5F5F5;
margin: 0 auto
}
.cont_form_head_mid {
position: relative;
text-align:center;
background:#708090;
border:1px solid #F5F5F5;
color:#FFFFB5;
padding:0
}
.cont_form1_1 {
padding:8px 20px 0px 20px;
border-top:solid 1px #CCCCCC
}
.cont_form1 {
padding:8px 20px 0px 20px
}
.cont_form2 {
padding:1px 20px 0px 20px
}
.cont_form3 {
width:358px;
height:20px;
background:#F5F5F5;
border:1px solid #CCCCCC;
color:#999
}
.cont_form_sub {
padding:5px;
text-align:center
}
.novalid {
display:none;
text-align: center;
background:#FFCFCF;
margin: 0 20px;
padding: 3px
}
input:enabled.submit { 
font-weight: bold;
padding: 3px 20px
}
</style>
<!-- // javascript можно вынести в отдельный файл "script.js" и подключить <script src="/script.js" type="text/javascript"></script> //-->
<script type="text/javascript">
function validate_form(form) {
 
<? if ($FirstName == true): ?>
if (form.name_field.value == 'Enter Your First Name Here' || form.name_field.value == '') {
        document.getElementById('FirstName').style.display="block";
        document.getElementById('FirstName2').style.display="none";
          form.name_field.focus();
            return false;
        } else {
        document.getElementById('FirstName').style.display="none";
        document.getElementById('FirstName2').style.display="block";
        }
<? endif; ?>
<? if ($Surname == true): ?>    
if (form.surname_field.value == 'Enter Your Surname Here' || form.surname_field.value == '') {
        document.getElementById('Surname').style.display="block";
        document.getElementById('Surname2').style.display="none";
          form.surname_field.focus();
            return false;
        } else {
        document.getElementById('Surname').style.display="none";
        document.getElementById('Surname2').style.display="block";
        }
<? endif; ?>
<? if ($Gender == true): ?> 
if (form.sex[0].checked == '' && form.sex[1].checked == '') {
        document.getElementById('Gender').style.display="block";
        document.getElementById('Gender2').style.display="none";
            return false;
        } else {
        document.getElementById('Gender').style.display="none";
        document.getElementById('Gender2').style.display="block";
        }
<? endif; ?>
<? if ($Age == true): ?>
if (form.age_field.value == 'Enter Your Age' || form.age_field.value == '') {
        document.getElementById('Age').style.display="block";
        document.getElementById('Age2').style.display="none";
          form.age_field.focus();
            return false;
        } else {
        document.getElementById('Age').style.display="none";
        document.getElementById('Age2').style.display="block";
        }
<? endif; ?>
<? if ($MobilePhoneNumber == true): ?>      
if (form.mobile_field.value == 'Enter Your Mobile Phone Number Here' || form.mobile_field.value == '') {
        document.getElementById('MobilePhoneNumber').style.display="block"; 
        document.getElementById('MobilePhoneNumber2').style.display="none";
          form.mobile_field.focus();
            return false;
        } else {
        document.getElementById('MobilePhoneNumber').style.display="none";
        document.getElementById('MobilePhoneNumber2').style.display="block";
        }
<? endif; ?>
<? if ($AreaCode == true): ?>
if (form.area_field.value == 'Enter Your Area Code Here' || form.area_field.value == '') {
        document.getElementById('AreaCode').style.display="block";  
        document.getElementById('AreaCode2').style.display="none";
          form.area_field.focus();
            return false;
        } else {
        document.getElementById('AreaCode').style.display="none";
        document.getElementById('AreaCode2').style.display="block";
        }
<? endif; ?>
<? if ($PhoneNumber == true): ?>        
if (form.phone_field.value == 'Enter Your Phone Number Here' || form.phone_field.value == '') {
        document.getElementById('PhoneNumber').style.display="block";   
        document.getElementById('PhoneNumber2').style.display="none";
          form.phone_field.focus();
            return false;
        } else {
        document.getElementById('PhoneNumber').style.display="none";
        document.getElementById('PhoneNumber2').style.display="block";
        }   
<? endif; ?>
<? if ($Address == true): ?>        
if (form.address_field.value == 'Enter Your Address Here' || form.address_field.value == '') {
        document.getElementById('Address').style.display="block";
        document.getElementById('Address2').style.display="none";
          form.address_field.focus();
            return false;
        } else {
        document.getElementById('Address').style.display="none";
        document.getElementById('Address2').style.display="block";
        }   
<? endif; ?>
<? if ($State == true): ?>      
if (form.state_field.value == 'Enter Your State Here' || form.state_field.value == '') {
        document.getElementById('State').style.display="block"; 
        document.getElementById('State2').style.display="none"; 
          form.state_field.focus();
            return false;
        } else {
        document.getElementById('State').style.display="none";
        document.getElementById('State2').style.display="block";    
        }
<? endif; ?>
<? if ($Country == true): ?>        
if(form.country_field.options[form.country_field.selectedIndex].value == 0) {
        document.getElementById('Country').style.display="block";
        document.getElementById('Country2').style.display="none";
            form.country_field.focus();
            return false;
        } else {
        document.getElementById('Country').style.display="none";
        document.getElementById('Country2').style.display="block";
        }
<? endif; ?>
<? if ($PostCode == true): ?>       
if (form.post_field.value == 'Enter Your Post Code' || form.post_field.value == '') {
        document.getElementById('PostCode').style.display="block";  
        document.getElementById('PostCode2').style.display="none";
          form.post_field.focus();
            return false;
        } else {
        document.getElementById('PostCode').style.display="none";
        document.getElementById('PostCode2').style.display="block";
        }       
<? endif; ?>
    document.getElementById('agree').disabled = 0;
return true; 
}
// Проверка ввода в поле только цифр
function check(input){
        input.value=input.value.replace(/[^\d,]/g,'');
}
// Предупреждение о правильно заполненных данных, если заполнены не все поля - кнопка отправить не активна!
function agreeForm(f) {
    if (f.agree.checked && validate_form(contact_form)) {
       alert('Проверьте ваши данные перед отправкой,\nчтобы мы могли с вами связаться!'); 
        f.submit.disabled = 0;
      } else {
        f.submit.disabled = 1;
      } 
  }
  
</script>
<!-- // Сама форма на странице // -->
<div class="cont_form_head">
  <form name="contact_form" action="sendmail.php" method="post" onsubmit="return validate_form(this);">
    <div class="cont_form_head_mid"><img class="website_logo" src="<?=$website_logo?>" alt="Logo website"><h2>CONTACT FORM</h2></div>
    
<? if ($FirstName == true): ?>      
<div class="cont_form1_1" id="FirstName2" style="display:block;">First Name:</div> <!-- // Название поля в форме -->
    <div id="FirstName" class="novalid">Пожалуйста, укажите First Name</div> <!-- // Всплывающее предупреждение о незаполненом поле -->
        <div class="cont_form2">
    <input name="name_field" type="text" value="Enter Your First Name Here" class="cont_form3" maxlength="15"
            onfocus="if(this.value=='Enter Your First Name Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your First Name Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($Surname == true): ?>
<div class="cont_form1" id="Surname2" style="display:block;">Surname:</div>
    <div id="Surname" class="novalid">Пожалуйста, укажите Surname</div>
        <div class="cont_form2">
    <input name="surname_field" type="text" value="Enter Your Surname Here" class="cont_form3" maxlength="15" 
            onfocus="if(this.value=='Enter Your Surname Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Surname Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($Gender == true): ?>
<div class="cont_form1" id="Gender2" style="display:block;">Gender:</div>
    <div id="Gender" class="novalid">Пожалуйста, укажите Gender</div>
        <div class="cont_form2">
    <label><input type="radio" name="sex" value="male" onchange="return validate_form(contact_form);"/>Male</label>  
    <label><input type="radio" name="sex" value="female" onchange="return validate_form(contact_form);"/>Female</label>
        </div>
<? endif; ?>
 
<? if ($Age == true): ?> 
<div class="cont_form1" id="Age2" style="display:block;">Age:</div>
    <div id="Age" class="novalid">Пожалуйста, укажите Age</div>
        <div class="cont_form2">
    <input name="age_field" type="text" value="Enter Your Age" onkeyup="return check(this);" class="cont_form3" maxlength="2" 
            onfocus="if(this.value=='Enter Your Age') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Age'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($MobilePhoneNumber == true): ?> 
<div class="cont_form1" id="MobilePhoneNumber2" style="display:block;">Mobile Phone Number:</div>
    <div id="MobilePhoneNumber" class="novalid">Пожалуйста, укажите Mobile Phone Number</div>
        <div class="cont_form2">
    <input name="mobile_field" type="text" value="Enter Your Mobile Phone Number Here" onkeyup="return check(this);" class="cont_form3" maxlength="15"
            onfocus="if(this.value=='Enter Your Mobile Phone Number Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Mobile Phone Number Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($AreaCode == true): ?>
<div class="cont_form1" id="AreaCode2" style="display:block;">Area Code:</div>
    <div id="AreaCode" class="novalid">Пожалуйста, укажите Area Code</div>
        <div class="cont_form2">     
    <input name="area_field" type="text" value="Enter Your Area Code Here" onkeyup="return check(this);" class="cont_form3" maxlength="3"    
            onfocus="if(this.value=='Enter Your Area Code Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Area Code Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($PhoneNumber == true): ?>
<div class="cont_form1" id="PhoneNumber2" style="display:block;">Phone Number:</div>
    <div id="PhoneNumber" class="novalid">Пожалуйста, укажите Phone Number</div>
        <div class="cont_form2">     
    <input name="phone_field" type="text" value="Enter Your Phone Number Here" onkeyup="return check(this);" class="cont_form3" maxlength="15"    
            onfocus="if(this.value=='Enter Your Phone Number Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Phone Number Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($Address == true): ?>
<div class="cont_form1" id="Address2" style="display:block;">Address:</div>
    <div id="Address" class="novalid">Пожалуйста, укажите Address</div>
        <div class="cont_form2">   
    <input name="address_field" type="text" value="Enter Your Address Here" class="cont_form3" maxlength="100"
            onfocus="if(this.value=='Enter Your Address Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your Address Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($State == true): ?> 
<div class="cont_form1" id="State2" style="display:block;">State:</div>
    <div id="State" class="novalid">Пожалуйста, укажите State</div>
        <div class="cont_form2">   
    <input name="state_field" type="text" value="Enter Your State Here" class="cont_form3" maxlength="15"
            onfocus="if(this.value=='Enter Your State Here') this.value=''; this.style.color='#000';"
            onblur="if(this.value=='') { this.value='Enter Your State Here'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
        </div>
<? endif; ?>
 
<? if ($Country == true): ?>
<div class="cont_form1" id="Country2" style="display:block;">Country:</div>
    <div id="Country" class="novalid">Пожалуйста, укажите Country</div>
      <div class="cont_form2">   
      <select name="country_field" onchange="return validate_form(contact_form);">
        <option value="">Select Country</option>
        <option value="United Kingdom">United Kingdom</option>
        <option value="Australia">Australia</option>
        <option value="Ukraine">Ukraine</option>
      </select>          
      </div>
<? endif; ?>
 
<? if ($PostCode == true): ?>     
<div class="cont_form1" id="PostCode2" style="display:block;">Post Code:</div>
    <div id="PostCode" class="novalid">Пожалуйста, укажите Post Code</div>
    <div class="cont_form2">   
      <input name="post_field" type="text" value="Enter Your Post Code" onkeyup="return check(this);" class="cont_form3" maxlength="6"
        onfocus="if(this.value=='Enter Your Post Code') this.value=''; this.style.color='#000';"
        onblur="if(this.value=='') { this.value='Enter Your Post Code'; this.style.color='#999'; } else { this.style.color='#000'; } return validate_form(contact_form);" />
    </div>
<? endif; ?>
 
<div class="cont_form2">
    <label><input type="checkbox" id="agree" name="agree" onclick="validate_form(contact_form);agreeForm(this.form);" disabled />Я согласен отправить данные</label>
</div>
 
<div class="cont_form_sub">
    <input type="submit" name="submit" class="submit" value="Send" disabled />
</div>
 
</form>
</div>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
<head>
<meta http-equiv="Content-type" content="text/html;charset=UTF-8" />
<title>Send Form</title>
 
</head>
<body>
<?php
include('contact_form.php');
?>
</body>
</html>

<?php
header("Content-Type: text/html; charset=UTF-8");
$to = 'programmist@alexgames.x10.mx'; //куда отправлять почту?
$from = "testscript@alexgames.x10.mx"; //адрес, от которого придёт уведомление - обязательно существующий почтовый ящик, желательно на сервере
$title='message from www.alexgames.x10.mx'; // подпись сообщения в почтовом ящике
$website_logo = 'http://'.$_SERVER['SERVER_NAME'].'/favicon.ico'; // если нет иконки, тогда указать вручную полный путь на /favicon.ico. Пример: "http://ваш_сайт/favicon.ico"
$ip = $_SERVER['REMOTE_ADDR']; // IP-адрес с которого отправили письмо
 
$name=$_POST['name_field'];
$fio=$_POST['surname_field'];
$sex=$_POST['sex'];
$email=$_POST['age_field'];
$tel=$_POST['mobile_field'];
$text=$_POST['area_field'];
$phone=$_POST['phone_field'];
$address=$_POST['address_field'];
$state=$_POST['state_field'];
$country=$_POST['country_field'];
$postcode=$_POST['post_field'];
 
$logo = '<img src="'.$website_logo.'" alt="Logo website">';
$headers  = "Content-type: text/html; charset=UTF-8 \r\n";
$headers .= "From: alexgames <".$from.">\r\n";
$mess = '<html><body>';
$mess .= '<table rules="all" style="border-color: #666; margin:0 auto; width: 90%; border-collapse: separate;" cellpadding="8">';
$mess .= "<tr style='background: #FCFFDB;'><td colspan='2'>".$logo."</td></tr>";
if (isset($name)) {
$mess .= "<tr style='background: #eee;'><td><strong>name:</strong></td><td><strong>".strip_tags($name)."</strong></td></tr>";
}
if (isset($fio)) {
$mess .= "<tr><td style='width: 190px;'><strong>fio:</strong></td><td><strong>".strip_tags($fio)."</strong></td></tr>";
}
if (isset($sex)) {
$mess .= "<tr><td style='width: 190px;'><strong>sex:</strong></td><td><strong>".strip_tags($sex)."</strong></td></tr>";
}
if (isset($email)) {
$mess .= "<tr style='background: #eee;'><td><strong>email:</strong></td><td><strong>".strip_tags($email)."</strong></td></tr>";
}
if (isset($tel)) {
$mess .= "<tr><td style='width: 190px;'><strong>tel:</strong></td><td><strong>".strip_tags($tel)."</strong></td></tr>";
}
if (isset($text)) {
$mess .= "<tr style='background: #eee;'><td><strong>text:</strong></td><td><strong>".strip_tags($text)."</strong></td></tr>";
}
if (isset($phone)) {
$mess .= "<tr><td style='width: 190px;'><strong>phone:</strong></td><td><strong>".strip_tags($phone)."</strong></td></tr>";
}
if (isset($address)) {
$mess .= "<tr style='background: #eee;'><td><strong>address:</strong></td><td><strong>".strip_tags($address)."</strong></td></tr>";
}
if (isset($state)) {
$mess .= "<tr><td style='width: 190px;'><strong>state:</strong></td><td><strong>".strip_tags($state)."</strong></td></tr>";
}
if (isset($country)) {
$mess .= "<tr style='background: #eee;'><td><strong>country:</strong></td><td><strong>".strip_tags($country)."</strong></td></tr>";
}
if (isset($postcode)) {
$mess .= "<tr><td style='width: 190px;'><strong>postcode:</strong></td><td><strong>".strip_tags($postcode)."</strong></td></tr>";
}
$mess .= "<tr style='background: #FCFFDB; text-align: center;'><td colspan='2'><i>Отправлено с IP-адреса: ".$ip."</i></td></tr>";
$mess .= "</table>";
$mess .= "</body></html>";
 
$mail_send = @mail($to, $title, $mess, $headers);
 
if($mail_send) {
//header('Refresh: 5; URL="http://alexgames.x10.mx"');
header('Refresh: 5; URL='.$_SERVER['HTTP_REFERER'].'');
echo '<h3>Mail sent OK!</h3>';
} else {
echo '<h3>Error Mail sent</h3>';
}
?>