RGS Title, LLC (451) -- RGS Title, LLC (287)

Visual Data Systems

title - Submit Title Order

FormID: 676 AccountID: 287

MOBILE LEGACY Contents for config-title.php file:
<?php $AccountID = 287; $formid = 676; $pageTitle = 'Contact Us: Submit Title Order | RGS Title'; $pageHeader = 'Submit Title Order'; $introText = '<p>We would like the opportunity to provide you with more information. Please fill in the simple form below, select the <strong>Submit</strong> button, and we will get back to you shortly. </p>'; $contactblock = "<li><label for='FirstName' class='inline'>First Name:</label> <input id='FirstName' type='text' required='required' placeholder='Required' name='FirstName' value='".(($_POST['FirstName'] <> "") ? htmlentities(stripslashes($_POST['FirstName']), ENT_QUOTES) : "")."' /></li> <li><label for='LastName' class='inline'>Last Name:</label> <input id='LastName' type='text' required='required' placeholder='Required' name='LastName' value='".(($_POST['LastName'] <> "") ? htmlentities(stripslashes($_POST['LastName']), ENT_QUOTES) : "")."' /></li> <li><label for='Email' class='inline'>Email:</label> <input id='email' type='email' required='required' placeholder='Required' name='Email' value='".(($_POST['Email'] <> "") ? htmlentities(stripslashes($_POST['Email']), ENT_QUOTES) : "")."' /></li> <li><label for='Phone' class='inline'>Phone:</label> <input id='tel' type='tel' required='required' placeholder='Required' name='Phone' value='".(($_POST['Phone'] <> "") ? htmlentities(stripslashes($_POST['Phone']), ENT_QUOTES) : "")."' /></li> <li><td colspan=2><table width=100%><tr><td colspan=3>Please indicate the methods by which we may contact you:</td></tr><tr><td><input type='checkbox' class=clear name='ApprovedContactEmail' value='1' ".(($_POST['ApprovedContactEmail'] == "1") ? "CHECKED" : "CHECKED")." />email</td><td><input type='checkbox' class=clear name='ApprovedContactPhone' value='1' ".(($_POST['ApprovedContactPhone'] == "1") ? "CHECKED" : "CHECKED")." />phone</td><td><input type='checkbox' class=clear name='ApprovedContactPost' value='1' ".(($_POST['ApprovedContactPost'] == "1") ? "CHECKED" : "CHECKED")." />post</td></tr></table></li> "; $questionblock = "<li><label for='MAID:0000003880'>Transaction Type: </label><select class='item' name='MAID:0000003880' size='1'><option value='0000048213' ".(($_POST['MAID:0000003880'] == '0000048213') ? "selected":"").">-select one-</option><option value='0000048214' ".(($_POST['MAID:0000003880'] == '0000048214') ? "selected":"").">Sale</option><option value='0000048215' ".(($_POST['MAID:0000003880'] == '0000048215') ? "selected":"").">Refinance</option></select></li> <li><label for='MAID:0000003881'>Office:</label><select class='item' name='MAID:0000003881' size='1'><option value='0000048216' ".(($_POST['MAID:0000003881'] == '0000048216') ? "selected":"").">-select one-</option></select></li> <li><label for='MAID:0000003882' class='oneline'>Sales Price:</label><input type='text' class='oneline' name='TEXT:0000003882' value='".(($_POST['TEXT:0000003882'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003882']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003883' class='oneline'>Loan Amount:</label><input type='text' class='oneline' name='TEXT:0000003883' value='".(($_POST['TEXT:0000003883'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003883']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003884' class='oneline'>Projected Closing Date:</label><input type='text' class='oneline' name='TEXT:0000003884' value='".(($_POST['TEXT:0000003884'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003884']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003885' class='oneline'>First/Last Name:</label><input type='text' class='oneline' name='TEXT:0000003885' value='".(($_POST['TEXT:0000003885'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003885']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003886' class='oneline'>Email:</label><input type='text' class='oneline' name='TEXT:0000003886' value='".(($_POST['TEXT:0000003886'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003886']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003887' class='oneline'>Phone:</label><input type='text' class='oneline' name='TEXT:0000003887' value='".(($_POST['TEXT:0000003887'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003887']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003888' class='oneline'>Applicant 1 First/Last Name:</label><input type='text' class='oneline' name='TEXT:0000003888' value='".(($_POST['TEXT:0000003888'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003888']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003889' class='oneline'>Applicant 1 Address:</label><input type='text' class='oneline' name='TEXT:0000003889' value='".(($_POST['TEXT:0000003889'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003889']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003890' class='oneline'>Applicant 1 Email:</label><input type='text' class='oneline' name='TEXT:0000003890' value='".(($_POST['TEXT:0000003890'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003890']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003891' class='oneline'>Applicant 1 Phone:</label><input type='text' class='oneline' name='TEXT:0000003891' value='".(($_POST['TEXT:0000003891'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003891']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003892'>Applicant 1 Marital Status:</label><select class='item' name='MAID:0000003892' size='1'><option value='0000048227' ".(($_POST['MAID:0000003892'] == '0000048227') ? "selected":"").">-select one-</option><option value='0000048228' ".(($_POST['MAID:0000003892'] == '0000048228') ? "selected":"").">Single</option><option value='0000048229' ".(($_POST['MAID:0000003892'] == '0000048229') ? "selected":"").">Married</option><option value='0000048230' ".(($_POST['MAID:0000003892'] == '0000048230') ? "selected":"").">Divorced</option></select></li> <li><label for='MAID:0000003893' class='oneline'>Applicant 2 First/Last Name:</label><input type='text' class='oneline' name='TEXT:0000003893' value='".(($_POST['TEXT:0000003893'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003893']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003894' class='oneline'>Applicant 2 Address:</label><input type='text' class='oneline' name='TEXT:0000003894' value='".(($_POST['TEXT:0000003894'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003894']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003895' class='oneline'>Applicant 2 Email: </label><input type='text' class='oneline' name='TEXT:0000003895' value='".(($_POST['TEXT:0000003895'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003895']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003896' class='oneline'>Applicant 2 Phone:</label><input type='text' class='oneline' name='TEXT:0000003896' value='".(($_POST['TEXT:0000003896'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003896']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003897'>Applicant 2 Marital Status:</label><select class='item' name='MAID:0000003897' size='1'><option value='0000048235' ".(($_POST['MAID:0000003897'] == '0000048235') ? "selected":"").">-select one-</option><option value='0000048236' ".(($_POST['MAID:0000003897'] == '0000048236') ? "selected":"").">Single</option><option value='0000048237' ".(($_POST['MAID:0000003897'] == '0000048237') ? "selected":"").">Married</option><option value='0000048238' ".(($_POST['MAID:0000003897'] == '0000048238') ? "selected":"").">Divorced</option></select></li> <li><label for='MAID:0000003898' class='oneline'>Seller First/Last Name:</label><input type='text' class='oneline' name='TEXT:0000003898' value='".(($_POST['TEXT:0000003898'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003898']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003900' class='oneline'>Seller Address:</label><input type='text' class='oneline' name='TEXT:0000003900' value='".(($_POST['TEXT:0000003900'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003900']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003899' class='oneline'>Seller Email:</label><input type='text' class='oneline' name='TEXT:0000003899' value='".(($_POST['TEXT:0000003899'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003899']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003901' class='oneline'>Seller Phone:</label><input type='text' class='oneline' name='TEXT:0000003901' value='".(($_POST['TEXT:0000003901'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003901']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003902'>Seller Marital Status:</label><select class='item' name='MAID:0000003902' size='1'><option value='0000048243' ".(($_POST['MAID:0000003902'] == '0000048243') ? "selected":"").">-select one-</option><option value='0000048244' ".(($_POST['MAID:0000003902'] == '0000048244') ? "selected":"").">Single</option><option value='0000048245' ".(($_POST['MAID:0000003902'] == '0000048245') ? "selected":"").">Married</option><option value='0000048246' ".(($_POST['MAID:0000003902'] == '0000048246') ? "selected":"").">Divorced</option></select></li> <li><label for='MAID:0000003903' class='oneline'>Property Address:</label><input type='text' class='oneline' name='TEXT:0000003903' value='".(($_POST['TEXT:0000003903'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003903']), ENT_QUOTES) : '')."' /></li> <li> <label for='TEXT:0000003904' class='oneline'>Questions and Comments:</label><textarea cols=60 rows=5 name='TEXT:0000003904'>".(($_POST['TEXT:0000003904'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003904']), ENT_QUOTES) : htmlentities(stripslashes(""), ENT_QUOTES))."</textarea></li> <li><label for='MAID:0000003905' class='oneline'>Sales Contract:</label><input type='text' class='oneline' name='TEXT:0000003905' value='(Upload)' /></li> <li><label for='MAID:0000003906' class='oneline'>Listing Agent Name:</label><input type='text' class='oneline' name='TEXT:0000003906' value='".(($_POST['TEXT:0000003906'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003906']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003907' class='oneline'>Listing Agent Phone:</label><input type='text' class='oneline' name='TEXT:0000003907' value='".(($_POST['TEXT:0000003907'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003907']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003908' class='oneline'>Listing Agent Email:</label><input type='text' class='oneline' name='TEXT:0000003908' value='".(($_POST['TEXT:0000003908'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003908']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003909' class='oneline'>Selling Agent Name:</label><input type='text' class='oneline' name='TEXT:0000003909' value='".(($_POST['TEXT:0000003909'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003909']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003910' class='oneline'>Selling Agent Phone:</label><input type='text' class='oneline' name='TEXT:0000003910' value='".(($_POST['TEXT:0000003910'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003910']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003911' class='oneline'>Selling Agent Email:</label><input type='text' class='oneline' name='TEXT:0000003911' value='".(($_POST['TEXT:0000003911'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003911']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003912' class='oneline'>Lender Name:</label><input type='text' class='oneline' name='TEXT:0000003912' value='".(($_POST['TEXT:0000003912'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003912']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003913' class='oneline'>Loan Officer Name:</label><input type='text' class='oneline' name='TEXT:0000003913' value='".(($_POST['TEXT:0000003913'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003913']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003914' class='oneline'>Loan Officer Phone:</label><input type='text' class='oneline' name='TEXT:0000003914' value='".(($_POST['TEXT:0000003914'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003914']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003915' class='oneline'>Loan Officer Email:</label><input type='text' class='oneline' name='TEXT:0000003915' value='".(($_POST['TEXT:0000003915'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003915']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003916' class='oneline'>Mortgagee Clause:</label><input type='text' class='oneline' name='TEXT:0000003916' value='".(($_POST['TEXT:0000003916'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003916']), ENT_QUOTES) : '')."' /></li> <li><label for='MAID:0000003917' class='oneline'>Please provide us with the following: </label><br/></li><li><input type='checkbox' class=clear name='MAID:0000003917:0' value='0000048261' ".(($_POST['MAID:0000003917:0'] == '0000048261') ? "checked='checked'":"")." />Title commitment </li><li><input type='checkbox' class=clear name='MAID:0000003917:1' value='0000048262' ".(($_POST['MAID:0000003917:1'] == '0000048262') ? "checked='checked'":"")." />Wiring Instructions </li><li><input type='checkbox' class=clear name='MAID:0000003917:2' value='0000048263' ".(($_POST['MAID:0000003917:2'] == '0000048263') ? "checked='checked'":"")." />Preliminary HUD </li> <li> <label for='TEXT:0000003918' class='oneline'>Questions and Comments:</label><textarea cols=60 rows=5 name='TEXT:0000003918'>".(($_POST['TEXT:0000003918'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000003918']), ENT_QUOTES) : htmlentities(stripslashes(""), ENT_QUOTES))."</textarea></li> "; $thanksTitle = 'Thank You'; $thanksHeader = 'Thanks for your time!'; $thanksText = '<P>Many thanks for contacting us. A representative will be responding to your on-line request shortly. We appreciate your business and will do our best to serve your needs! </p>';