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<html>
<head><title>Combined Feedback Form</title></head>
<body>
<?php
$self = $_SERVER['PHP_SELF'];
$username = $_POST['username'];
$useraddr = $_POST['useraddr'];
$comments = $_POST['comments'];
$sent = $_POST['sent'];
$form ="<form action=\"$self\" method=\"post\">";
$form.="Name:<input type=\"text\" name=\"username\"";
$form.=" size=\"30\" value=\"$username\" >";
$form.="Email:<input type=\"text\" name=\"useraddr\"";
$form.=" size=\"30\" value=\"$useraddr\">";
$form.="Comments:<textarea name=\"comments\" >";
$form.="$comments</textarea><br/>";
$form.="<input type=\"submit\" name=\"sent\" value=\"Send Form\">";
$form.="</form>";
if($sent)
{
$valid=true;
if( !$username )
{ $errmsg.="Enter your name...<br />"; $valid = false; }
if( !$useraddr )
{ $errmsg .="Enter your email address...<br />"; $valid = false; }
if( !$comments )
{ $errmsg.="Enter your comments...<br />"; $valid = false; }
$useraddr = trim($useraddr);
$_name = "/^[-!#$%&\'*+\\.\/0-9=?A-Z^_'{|}~]+";
$_host = "([-0-9A-Z]+\.)+";
$_tlds = "([0-9A-Z]){2,4}$/i";
if( !preg_match( $_name."@".$_host .$_tlds,$useraddr ) )
{
$errmsg.="Email address has incorrect format!<br />";
$valid=false;
}
}
if($valid != true)
{
echo( $errmsg.$form );
}
else
{
$to = "php@h.com";
$re = "Feedback from $username";
$msg = $comments;
$headers = "MIME-Version: 1.0\r\n";
$headers .= "Content-type: text/html;";
$headers .= "charset=\"iso-8859-1\"\r\n";
$headers .= "From: $useraddr \r\n";
if(mail($to,$re,$msg, $headers))
{ echo("Your comments have been sent - thanks $username");}
}
?>
</body></html>
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