Beach House Logos (433) -- Beach House Logos OptIn (263)

Visual Data Systems

contact - Beach House Logos Contact Form

FormID: 410 AccountID: 263

LEGACY Contents for config-contact.php file:
<?php $AccountID = 263; $formid = 410; $pageTitle = 'Contact Us | Beach House Logos'; $pageHeader = 'Contact Us For More Information'; $introText = '<p>We look forward to hearing from you. Please fill in as much information as possible on the form below so that we can best answer your questions and address your comments. Any information collected remains private. We promise not to sell your information, spam you, or use your e-mail address in any way other than to correspond with you. Thank you for your interest.</p>'; $template = $Root.'/Templates/page2.dwt'; $contactblock = "<tr><td colspan=4><table width=100%><tr><td align=right class=label>First Name:</td><td width=85%><input type='text' name='FirstName' value='".(($_POST['FirstName'] <> "") ? htmlentities(stripslashes($_POST['FirstName']), ENT_QUOTES) : "")."' size=24 maxlength=24 />$reqsymbol</td></tr> <tr><td align=right class=label>Last Name:</td><td width=85%><input type='text' name='LastName' value='".(($_POST['LastName'] <> "") ? htmlentities(stripslashes($_POST['LastName']), ENT_QUOTES) : "")."' size=32 maxlength=32 /></td></tr> <tr><td align=right class=label>Email:</td><td width=85%><input type='text' name='Email' value='".(($_POST['Email'] <> "") ? htmlentities(stripslashes($_POST['Email']), ENT_QUOTES) : "")."' size=32 maxlength=64 />$reqsymbol</td></tr> <tr><td align=right class=label>Phone:</td><td width=85%><input type='text' name='Phone' value='".(($_POST['Phone'] <> "") ? htmlentities(stripslashes($_POST['Phone']), ENT_QUOTES) : "")."' size=16 maxlength=16 /></td></tr> <tr><td align=right class=label>Address 1:</td><td width=85%><input type='text' name='Address1' value='".(($_POST['Address1'] <> "") ? htmlentities(stripslashes($_POST['Address1']), ENT_QUOTES) : "")."' size=44 maxlength=48 /></td></tr> <tr><td align=right class=label>City:</td><td width=85%><input type='text' name='City' value='".(($_POST['City'] <> "") ? htmlentities(stripslashes($_POST['City']), ENT_QUOTES) : "")."' size=24 maxlength=24 /></td></tr> <tr><td align=right class=label>State:</td><td><select name='State' size='1'><option value='' SELECTED>[State]</option><option value='ZZ'".(($_POST['State'] == 'ZZ') ? "selected" : "").">International</option><option value='AL'".(($_POST['State'] == 'AL') ? "selected" : "").">AL-Alabama</option><option value='AK'".(($_POST['State'] == 'AK') ? "selected" : "").">AK-Alaska</option><option value='AZ'".(($_POST['State'] == 'AZ') ? "selected" : "").">AZ-Arizona</option><option value='AR'".(($_POST['State'] == 'AR') ? "selected" : "").">AR-Arkansas</option><option value='CA'".(($_POST['State'] == 'CA') ? "selected" : "").">CA-California</option><option value='CO'".(($_POST['State'] == 'CO') ? "selected" : "").">CO-Colorado</option><option value='CT'".(($_POST['State'] == 'CT') ? "selected" : "").">CT-Connecticut</option><option value='DC'".(($_POST['State'] == 'DC') ? "selected" : "").">DC-Washington D.C.</option><option value='DE'".(($_POST['State'] == 'DE') ? "selected" : "").">DE-Delaware</option><option value='FL'".(($_POST['State'] == 'FL') ? "selected" : "").">FL-Florida</option><option value='GA'".(($_POST['State'] == 'GA') ? "selected" : "").">GA-Georgia</option><option value='HI'".(($_POST['State'] == 'HI') ? "selected" : "").">HI-Hawaii</option><option value='ID'".(($_POST['State'] == 'ID') ? "selected" : "").">ID-Idaho</option><option value='IL'".(($_POST['State'] == 'IL') ? "selected" : "").">IL-Illinois</option><option value='IN'".(($_POST['State'] == 'IN') ? "selected" : "").">IN-Indiana</option><option value='IA'".(($_POST['State'] == 'IA') ? "selected" : "").">IA-Iowa</option><option value='KS'".(($_POST['State'] == 'KS') ? "selected" : "").">KS-Kansas</option><option value='KY'".(($_POST['State'] == 'KY') ? "selected" : "").">KY-Kentucky</option><option value='LA'".(($_POST['State'] == 'LA') ? "selected" : "").">LA-Louisiana</option><option value='ME'".(($_POST['State'] == 'ME') ? "selected" : "").">ME-Maine</option><option value='MD'".(($_POST['State'] == 'MD') ? "selected" : "").">MD-Maryland</option><option value='MA'".(($_POST['State'] == 'MA') ? "selected" : "").">MA-Massachusetts</option><option value='MI'".(($_POST['State'] == 'MI') ? "selected" : "").">MI-Michigan</option><option value='MN'".(($_POST['State'] == 'MN') ? "selected" : "").">MN-Minnesota</option><option value='MS'".(($_POST['State'] == 'MS') ? "selected" : "").">MS-Mississippi</option><option value='MO'".(($_POST['State'] == 'MO') ? "selected" : "").">MO-Missouri</option><option value='MT'".(($_POST['State'] == 'MT') ? "selected" : "").">MT-Montana</option><option value='NE'".(($_POST['State'] == 'NE') ? "selected" : "").">NE-Nebraska</option><option value='NV'".(($_POST['State'] == 'NV') ? "selected" : "").">NV-Nevada</option><option value='NH'".(($_POST['State'] == 'NH') ? "selected" : "").">NH-New Hampshire</option><option value='NJ'".(($_POST['State'] == 'NJ') ? "selected" : "").">NJ-New Jersey</option><option value='NM'".(($_POST['State'] == 'NM') ? "selected" : "").">NM-New Mexico</option><option value='NY'".(($_POST['State'] == 'NY') ? "selected" : "").">NY-New York</option><option value='NC'".(($_POST['State'] == 'NC') ? "selected" : "").">NC-North Carolina</option><option value='ND'".(($_POST['State'] == 'ND') ? "selected" : "").">ND-North Dakota</option><option value='OH'".(($_POST['State'] == 'OH') ? "selected" : "").">OH-Ohio</option><option value='OK'".(($_POST['State'] == 'OK') ? "selected" : "").">OK-Oklahoma</option><option value='OR'".(($_POST['State'] == 'OR') ? "selected" : "").">OR-Oregon</option><option value='PA'".(($_POST['State'] == 'PA') ? "selected" : "").">PA-Pennsylvania</option><option value='PR'".(($_POST['State'] == 'PR') ? "selected" : "").">PR-Puerto Rico</option><option value='RI'".(($_POST['State'] == 'RI') ? "selected" : "").">RI-Rhode Island</option><option value='SC'".(($_POST['State'] == 'SC') ? "selected" : "").">SC-South Carolina</option><option value='SD'".(($_POST['State'] == 'SD') ? "selected" : "").">SD-South Dakota</option><option value='TN'".(($_POST['State'] == 'TN') ? "selected" : "").">TN-Tennessee</option><option value='TX'".(($_POST['State'] == 'TX') ? "selected" : "").">TX-Texas</option><option value='UT'".(($_POST['State'] == 'UT') ? "selected" : "").">UT-Utah</option><option value='VT'".(($_POST['State'] == 'VT') ? "selected" : "").">VT-Vermont</option><option value='VA'".(($_POST['State'] == 'VA') ? "selected" : "").">VA-Virginia</option><option value='WA'".(($_POST['State'] == 'WA') ? "selected" : "").">WA-Washington</option><option value='WV'".(($_POST['State'] == 'WV') ? "selected" : "").">WV-West Virginia</option><option value='WI'".(($_POST['State'] == 'WI') ? "selected" : "").">WI-Wisconsin</option><option value='WY'".(($_POST['State'] == 'WY') ? "selected" : "").">WY-Wyoming</option></select>$reqsymbol</td></tr> <tr><td align=right class=label>Zip:</td><td width=85%><input type='text' name='Zip' value='".(($_POST['Zip'] <> "") ? htmlentities(stripslashes($_POST['Zip']), ENT_QUOTES) : "")."' size=10 maxlength=10 />$reqsymbol</td></tr> <tr><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></td></tr> </table></td></tr>"; $questionblock = "<tr><td colspan=2><input type='checkbox' class=clear name='MAID:0000002815' value='0000043096' CHECKED /><b>Please email me to announce price reductions or new products.</b></td></tr> <tr><td class=label colspan=2><b>Send me information on the following types of products:</b></td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000002870:0' value='0000043295' ".(($_POST['MAID:0000002870:0'] == '0000043295') ? "checked='checked'":"")." />Welcome Gifts </td><td>   <input type='checkbox' class=clear name='MAID:0000002870:1' value='0000043296' ".(($_POST['MAID:0000002870:1'] == '0000043296') ? "checked='checked'":"")." />Staff Apparel </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000002870:2' value='0000043297' ".(($_POST['MAID:0000002870:2'] == '0000043297') ? "checked='checked'":"")." />Trade Show Giveaways </td><td>   <input type='checkbox' class=clear name='MAID:0000002870:3' value='0000043298' ".(($_POST['MAID:0000002870:3'] == '0000043298') ? "checked='checked'":"")." />Fundraising Products </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000002870:4' value='0000043299' ".(($_POST['MAID:0000002870:4'] == '0000043299') ? "checked='checked'":"")." />Homeowner Guest Connect Gifts </td><td>   <input type='checkbox' class=clear name='MAID:0000002870:5' value='0000043313' ".(($_POST['MAID:0000002870:5'] == '0000043313') ? "checked='checked'":"")." />Pet Friendly Products </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000002870:6' value='0000043314' ".(($_POST['MAID:0000002870:6'] == '0000043314') ? "checked='checked'":"")." />Kid Friendly Items </td><td>   <input type='checkbox' class=clear name='MAID:0000002870:7' value='0000043315' ".(($_POST['MAID:0000002870:7'] == '0000043315') ? "checked='checked'":"")." />Pens/Pad </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000002870:8' value='0000043316' ".(($_POST['MAID:0000002870:8'] == '0000043316') ? "checked='checked'":"")." />Magnets/Decals </td> <tr><td><b>How did you find us?</b></td><td><select class='item' name='MAID:0000002816' size='1'><option value='0000043097' ".(($_POST['MAID:0000002816'] == '0000043097') ? "selected":"").">-select one-</option><option value='0000043098' ".(($_POST['MAID:0000002816'] == '0000043098') ? "selected":"").">Google</option><option value='0000043099' ".(($_POST['MAID:0000002816'] == '0000043099') ? "selected":"").">Yahoo!</option><option value='0000043100' ".(($_POST['MAID:0000002816'] == '0000043100') ? "selected":"").">Bing</option><option value='0000043101' ".(($_POST['MAID:0000002816'] == '0000043101') ? "selected":"").">Ask.com</option><option value='0000043102' ".(($_POST['MAID:0000002816'] == '0000043102') ? "selected":"").">Other Internet</option><option value='0000043103' ".(($_POST['MAID:0000002816'] == '0000043103') ? "selected":"").">Print Publication</option><option value='0000043104' ".(($_POST['MAID:0000002816'] == '0000043104') ? "selected":"").">Personal Referral</option><option value='0000043300' ".(($_POST['MAID:0000002816'] == '0000043300') ? "selected":"").">VRMA</option><option value='0000043361' ".(($_POST['MAID:0000002816'] == '0000043361') ? "selected":"").">ARDA</option><option value='0000043362' ".(($_POST['MAID:0000002816'] == '0000043362') ? "selected":"").">FLVRMA</option><option value='0000043363' ".(($_POST['MAID:0000002816'] == '0000043363') ? "selected":"").">NCVRMA</option><option value='0000043364' ".(($_POST['MAID:0000002816'] == '0000043364') ? "selected":"").">ARVC</option></select></td></tr> <tr><td><b>Have you ordered from Beach House Logos in the past?</b></td><td><select class='item' name='MAID:0000002871' size='1'><option value='0000043301' ".(($_POST['MAID:0000002871'] == '0000043301') ? "selected":"").">-select one-</option><option value='0000043302' ".(($_POST['MAID:0000002871'] == '0000043302') ? "selected":"").">Yes</option><option value='0000043303' ".(($_POST['MAID:0000002871'] == '0000043303') ? "selected":"").">No</option></select></td></tr> <tr><td colspan=2><b> Comments/remarks:</b></td></tr><tr><td colspan=2><textarea cols=60 rows=5 name='TEXT:0000002872'>".(($_POST['TEXT:0000002872'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000002872']), ENT_QUOTES) : htmlentities(stripslashes(""), ENT_QUOTES))."</textarea></td></tr> "; $thanksTitle = 'Thank You | Beach House Logos'; $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>';