Hatteras Realty (20) -- Hatteras Realty Contacts (32)

bconfirm - Brochure Confirmation

FormID: 788 AccountID: 32

LEGACY Contents for config-bconfirm.php file: <?php $AccountID = 32; $formid = 788; $pageTitle = 'Brochure Address Confirmation'; $pageHeader = 'Please Confirm Your Address to Receive Our Latest Brochure'; $introText = '<p>Please confirm your mailing address by submitting the form below, and we\'ll send you the latest Hatteras Realty vacation rental brochure. </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 />$reqsymbol</td></tr> <tr><td align=right class=label>Email:</td><td width=85%><input type='text' name='Email' value='".(($_POST['Email'] <> "") ? htmlentities(stripslashes($_POST['Email']), ENT_QUOTES) : "")."' size=32 maxlength=64 />$reqsymbol</td></tr> <tr><td align=right class=label>Alternate Phone:</td><td width=85%><input type='text' name='Phone2' value='".(($_POST['Phone2'] <> "") ? htmlentities(stripslashes($_POST['Phone2']), 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 />$reqsymbol</td></tr> <tr><td align=right class=label>Address 2:</td><td width=85%><input type='text' name='Address2' value='".(($_POST['Address2'] <> "") ? htmlentities(stripslashes($_POST['Address2']), ENT_QUOTES) : "")."' size=44 maxlength=48 /></td></tr> <tr><td align=right class=label>City:</td><td width=85%><input type='text' name='City' value='".(($_POST['City'] <> "") ? htmlentities(stripslashes($_POST['City']), ENT_QUOTES) : "")."' size=24 maxlength=24 />$reqsymbol</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 />$reqsymbol</td></tr> <tr><td align=right class=label>Country:</td><td><select name='Country' size='1'><option value='' SELECTED>[Country]</option><option value='United States'".(($_POST['Country'] == 'United States') ? "selected" : "").">United States</option><option value='Canada'".(($_POST['Country'] == 'Canada') ? "selected" : "").">Canada</option><option value='Afghanistan'".(($_POST['Country'] == 'Afghanistan') ? "selected" : "").">Afghanistan</option><option value='Albania'".(($_POST['Country'] == 'Albania') ? "selected" : "").">Albania</option><option value='Algeria'".(($_POST['Country'] == 'Algeria') ? "selected" : "").">Algeria</option><option value='American Samoa'".(($_POST['Country'] == 'American Samoa') ? "selected" : "").">American Samoa</option><option value='Andorra'".(($_POST['Country'] == 'Andorra') ? "selected" : "").">Andorra</option><option value='Angola'".(($_POST['Country'] == 'Angola') ? "selected" : "").">Angola</option><option value='Anguilla'".(($_POST['Country'] == 'Anguilla') ? "selected" : "").">Anguilla</option><option value='Antarctica'".(($_POST['Country'] == 'Antarctica') ? "selected" : "").">Antarctica</option><option value='Antigua And Barbuda'".(($_POST['Country'] == 'Antigua And Barbuda') ? "selected" : "").">Antigua And Barbuda</option><option value='Argentina'".(($_POST['Country'] == 'Argentina') ? "selected" : "").">Argentina</option><option value='Armenia'".(($_POST['Country'] == 'Armenia') ? "selected" : "").">Armenia</option><option value='Aruba'".(($_POST['Country'] == 'Aruba') ? "selected" : "").">Aruba</option><option value='Australia'".(($_POST['Country'] == 'Australia') ? "selected" : "").">Australia</option><option value='Austria'".(($_POST['Country'] == 'Austria') ? "selected" : "").">Austria</option><option value='Azerbaijan'".(($_POST['Country'] == 'Azerbaijan') ? "selected" : "").">Azerbaijan</option><option value='Bahamas'".(($_POST['Country'] == 'Bahamas') ? "selected" : "").">Bahamas</option><option value='Bahrain'".(($_POST['Country'] == 'Bahrain') ? "selected" : "").">Bahrain</option><option value='Bangladesh'".(($_POST['Country'] == 'Bangladesh') ? "selected" : "").">Bangladesh</option><option value='Barbados'".(($_POST['Country'] == 'Barbados') ? "selected" : "").">Barbados</option><option value='Belarus'".(($_POST['Country'] == 'Belarus') ? "selected" : "").">Belarus</option><option value='Belgium'".(($_POST['Country'] == 'Belgium') ? "selected" : "").">Belgium</option><option value='Belize'".(($_POST['Country'] == 'Belize') ? "selected" : "").">Belize</option><option value='Benin'".(($_POST['Country'] == 'Benin') ? "selected" : "").">Benin</option><option value='Bermuda'".(($_POST['Country'] == 'Bermuda') ? "selected" : "").">Bermuda</option><option value='Bhutan'".(($_POST['Country'] == 'Bhutan') ? "selected" : "").">Bhutan</option><option value='Bolivia'".(($_POST['Country'] == 'Bolivia') ? "selected" : "").">Bolivia</option><option value='Bosnia And Herzegowina'".(($_POST['Country'] == 'Bosnia And Herzegowina') ? "selected" : "").">Bosnia And Herzegowina</option><option value='Botswana'".(($_POST['Country'] == 'Botswana') ? "selected" : "").">Botswana</option><option value='Bouvet Island'".(($_POST['Country'] == 'Bouvet Island') ? "selected" : "").">Bouvet Island</option><option value='Brazil'".(($_POST['Country'] == 'Brazil') ? "selected" : "").">Brazil</option><option value='British Indian Ocean Territory'".(($_POST['Country'] == 'British Indian Ocean Territory') ? "selected" : "").">British Indian Ocean Territory</option><option value='Brunei Darussalam'".(($_POST['Country'] == 'Brunei Darussalam') ? "selected" : "").">Brunei Darussalam</option><option value='Bulgaria'".(($_POST['Country'] == 'Bulgaria') ? "selected" : "").">Bulgaria</option><option value='Burkina Faso'".(($_POST['Country'] == 'Burkina Faso') ? "selected" : "").">Burkina Faso</option><option value='Burundi'".(($_POST['Country'] == 'Burundi') ? "selected" : "").">Burundi</option><option value='Cambodia'".(($_POST['Country'] == 'Cambodia') ? "selected" : "").">Cambodia</option><option value='Cameroon'".(($_POST['Country'] == 'Cameroon') ? "selected" : "").">Cameroon</option><option value='Canada'".(($_POST['Country'] == 'Canada') ? "selected" : "").">Canada</option><option value='Cape Verde'".(($_POST['Country'] == 'Cape Verde') ? "selected" : "").">Cape Verde</option><option value='Cayman Islands'".(($_POST['Country'] == 'Cayman Islands') ? "selected" : "").">Cayman Islands</option><option value='Central African Republic'".(($_POST['Country'] == 'Central African Republic') ? "selected" : "").">Central African Republic</option><option value='Chad'".(($_POST['Country'] == 'Chad') ? "selected" : "").">Chad</option><option value='Chile'".(($_POST['Country'] == 'Chile') ? "selected" : "").">Chile</option><option value='China'".(($_POST['Country'] == 'China') ? "selected" : "").">China</option><option value='Christmas Island'".(($_POST['Country'] == 'Christmas Island') ? "selected" : "").">Christmas Island</option><option value='Cocos (Keeling) Islands'".(($_POST['Country'] == 'Cocos (Keeling) Islands') ? "selected" : "").">Cocos (Keeling) Islands</option><option value='Colombia'".(($_POST['Country'] == 'Colombia') ? "selected" : "").">Colombia</option><option value='Comoros'".(($_POST['Country'] == 'Comoros') ? "selected" : "").">Comoros</option><option value='Congo'".(($_POST['Country'] == 'Congo') ? "selected" : "").">Congo</option><option value='Cook Islands'".(($_POST['Country'] == 'Cook Islands') ? "selected" : "").">Cook Islands</option><option value='Costa Rica'".(($_POST['Country'] == 'Costa Rica') ? "selected" : "").">Costa Rica</option><option value='Cote D\'Ivoire'".(($_POST['Country'] == 'Cote D\'Ivoire') ? "selected" : "").">Cote D\'Ivoire</option><option value='Croatia'".(($_POST['Country'] == 'Croatia') ? "selected" : "").">Croatia</option><option value='Cuba'".(($_POST['Country'] == 'Cuba') ? "selected" : "").">Cuba</option><option value='Cyprus'".(($_POST['Country'] == 'Cyprus') ? "selected" : "").">Cyprus</option><option value='Czech Republic'".(($_POST['Country'] == 'Czech Republic') ? "selected" : "").">Czech Republic</option><option value='Denmark'".(($_POST['Country'] == 'Denmark') ? "selected" : "").">Denmark</option><option value='Djibouti'".(($_POST['Country'] == 'Djibouti') ? "selected" : "").">Djibouti</option><option value='Dominica'".(($_POST['Country'] == 'Dominica') ? "selected" : "").">Dominica</option><option value='Dominican Republic'".(($_POST['Country'] == 'Dominican Republic') ? "selected" : "").">Dominican Republic</option><option value='East Timor'".(($_POST['Country'] == 'East Timor') ? "selected" : "").">East Timor</option><option value='Ecuador'".(($_POST['Country'] == 'Ecuador') ? "selected" : "").">Ecuador</option><option value='Egypt'".(($_POST['Country'] == 'Egypt') ? "selected" : "").">Egypt</option><option value='El Salvador'".(($_POST['Country'] == 'El Salvador') ? "selected" : "").">El Salvador</option><option value='Equatorial Guinea'".(($_POST['Country'] == 'Equatorial Guinea') ? "selected" : "").">Equatorial Guinea</option><option value='Eritrea'".(($_POST['Country'] == 'Eritrea') ? "selected" : "").">Eritrea</option><option value='Estonia'".(($_POST['Country'] == 'Estonia') ? "selected" : "").">Estonia</option><option value='Ethiopia'".(($_POST['Country'] == 'Ethiopia') ? "selected" : "").">Ethiopia</option><option value='Falkland Islands'".(($_POST['Country'] == 'Falkland Islands') ? "selected" : "").">Falkland Islands</option><option value='Faroe Islands'".(($_POST['Country'] == 'Faroe Islands') ? "selected" : "").">Faroe Islands</option><option value='Fiji'".(($_POST['Country'] == 'Fiji') ? "selected" : "").">Fiji</option><option value='Finland'".(($_POST['Country'] == 'Finland') ? "selected" : "").">Finland</option><option value='France'".(($_POST['Country'] == 'France') ? "selected" : "").">France</option><option value='France, Metropolitan'".(($_POST['Country'] == 'France, Metropolitan') ? "selected" : "").">France, Metropolitan</option><option value='French Guiana'".(($_POST['Country'] == 'French Guiana') ? "selected" : "").">French Guiana</option><option value='French Polynesia'".(($_POST['Country'] == 'French Polynesia') ? "selected" : "").">French Polynesia</option><option value='French Southern Territories'".(($_POST['Country'] == 'French Southern Territories') ? "selected" : "").">French Southern Territories</option><option value='Gabon'".(($_POST['Country'] == 'Gabon') ? "selected" : "").">Gabon</option><option value='Gambia'".(($_POST['Country'] == 'Gambia') ? "selected" : "").">Gambia</option><option value='Georgia'".(($_POST['Country'] == 'Georgia') ? "selected" : "").">Georgia</option><option value='Germany'".(($_POST['Country'] == 'Germany') ? "selected" : "").">Germany</option><option value='Ghana'".(($_POST['Country'] == 'Ghana') ? "selected" : "").">Ghana</option><option value='Gibraltar'".(($_POST['Country'] == 'Gibraltar') ? "selected" : "").">Gibraltar</option><option value='Greece'".(($_POST['Country'] == 'Greece') ? "selected" : "").">Greece</option><option value='Greenland'".(($_POST['Country'] == 'Greenland') ? "selected" : "").">Greenland</option><option value='Grenada'".(($_POST['Country'] == 'Grenada') ? "selected" : "").">Grenada</option><option value='Guadeloupe'".(($_POST['Country'] == 'Guadeloupe') ? "selected" : "").">Guadeloupe</option><option value='Guam'".(($_POST['Country'] == 'Guam') ? "selected" : "").">Guam</option><option value='Guatemala'".(($_POST['Country'] == 'Guatemala') ? "selected" : "").">Guatemala</option><option value='Guinea'".(($_POST['Country'] == 'Guinea') ? "selected" : "").">Guinea</option><option value='Guinea-Bissau'".(($_POST['Country'] == 'Guinea-Bissau') ? "selected" : "").">Guinea-Bissau</option><option value='Guyana'".(($_POST['Country'] == 'Guyana') ? "selected" : "").">Guyana</option><option value='Haiti'".(($_POST['Country'] == 'Haiti') ? "selected" : "").">Haiti</option><option value='Heard And Mc Donald Islands'".(($_POST['Country'] == 'Heard And Mc Donald Islands') ? "selected" : "").">Heard And Mc Donald Islands</option><option value='Honduras'".(($_POST['Country'] == 'Honduras') ? "selected" : "").">Honduras</option><option value='Hong Kong'".(($_POST['Country'] == 'Hong Kong') ? "selected" : "").">Hong Kong</option><option value='Hungary'".(($_POST['Country'] == 'Hungary') ? "selected" : "").">Hungary</option><option value='Iceland'".(($_POST['Country'] == 'Iceland') ? "selected" : "").">Iceland</option><option value='India'".(($_POST['Country'] == 'India') ? "selected" : "").">India</option><option value='Indonesia'".(($_POST['Country'] == 'Indonesia') ? "selected" : "").">Indonesia</option><option value='Iran'".(($_POST['Country'] == 'Iran') ? "selected" : "").">Iran</option><option value='Iraq'".(($_POST['Country'] == 'Iraq') ? "selected" : "").">Iraq</option><option value='Ireland'".(($_POST['Country'] == 'Ireland') ? "selected" : "").">Ireland</option><option value='Israel'".(($_POST['Country'] == 'Israel') ? "selected" : "").">Israel</option><option value='Italy'".(($_POST['Country'] == 'Italy') ? "selected" : "").">Italy</option><option value='Jamaica'".(($_POST['Country'] == 'Jamaica') ? "selected" : "").">Jamaica</option><option value='Japan'".(($_POST['Country'] == 'Japan') ? "selected" : "").">Japan</option><option value='Jordan'".(($_POST['Country'] == 'Jordan') ? "selected" : "").">Jordan</option><option value='Kazakhstan'".(($_POST['Country'] == 'Kazakhstan') ? "selected" : "").">Kazakhstan</option><option value='Kenya'".(($_POST['Country'] == 'Kenya') ? "selected" : "").">Kenya</option><option value='Kiribati'".(($_POST['Country'] == 'Kiribati') ? "selected" : "").">Kiribati</option><option value='North Korea (People\'s Republic Of Korea)'".(($_POST['Country'] == 'North Korea (People\'s Republic Of Korea)') ? "selected" : "").">North Korea (People\'s Republic Of Korea)</option><option value='South Korea (Republic Of Korea)'".(($_POST['Country'] == 'South Korea (Republic Of Korea)') ? "selected" : "").">South Korea (Republic Of Korea)</option><option value='Kuwait'".(($_POST['Country'] == 'Kuwait') ? "selected" : "").">Kuwait</option><option value='Kyrgyzstan'".(($_POST['Country'] == 'Kyrgyzstan') ? "selected" : "").">Kyrgyzstan</option><option value='Lao People\'s Republic'".(($_POST['Country'] == 'Lao People\'s Republic') ? "selected" : "").">Lao People\'s Republic</option><option value='Latvia'".(($_POST['Country'] == 'Latvia') ? "selected" : "").">Latvia</option><option value='Lebanon'".(($_POST['Country'] == 'Lebanon') ? "selected" : "").">Lebanon</option><option value='Lesotho'".(($_POST['Country'] == 'Lesotho') ? "selected" : "").">Lesotho</option><option value='Liberia'".(($_POST['Country'] == 'Liberia') ? "selected" : "").">Liberia</option><option value='Libyan Arab Jamahiriya'".(($_POST['Country'] == 'Libyan Arab Jamahiriya') ? "selected" : "").">Libyan Arab Jamahiriya</option><option value='Liechtenstein'".(($_POST['Country'] == 'Liechtenstein') ? "selected" : "").">Liechtenstein</option><option value='Lithuania'".(($_POST['Country'] == 'Lithuania') ? "selected" : "").">Lithuania</option><option value='Luxembourg'".(($_POST['Country'] == 'Luxembourg') ? "selected" : "").">Luxembourg</option><option value='Macau'".(($_POST['Country'] == 'Macau') ? "selected" : "").">Macau</option><option value='Macedonia'".(($_POST['Country'] == 'Macedonia') ? "selected" : "").">Macedonia</option><option value='Madagascar'".(($_POST['Country'] == 'Madagascar') ? "selected" : "").">Madagascar</option><option value='Malawi'".(($_POST['Country'] == 'Malawi') ? "selected" : "").">Malawi</option><option value='Malaysia'".(($_POST['Country'] == 'Malaysia') ? "selected" : "").">Malaysia</option><option value='Maldives'".(($_POST['Country'] == 'Maldives') ? "selected" : "").">Maldives</option><option value='Mali'".(($_POST['Country'] == 'Mali') ? "selected" : "").">Mali</option><option value='Malta'".(($_POST['Country'] == 'Malta') ? "selected" : "").">Malta</option><option value='Marshall Islands'".(($_POST['Country'] == 'Marshall Islands') ? "selected" : "").">Marshall Islands</option><option value='Martinique'".(($_POST['Country'] == 'Martinique') ? "selected" : "").">Martinique</option><option value='Mauritania'".(($_POST['Country'] == 'Mauritania') ? "selected" : "").">Mauritania</option><option value='Mauritius'".(($_POST['Country'] == 'Mauritius') ? "selected" : "").">Mauritius</option><option value='Mayotte'".(($_POST['Country'] == 'Mayotte') ? "selected" : "").">Mayotte</option><option value='Mexico'".(($_POST['Country'] == 'Mexico') ? "selected" : "").">Mexico</option><option value='Micronesia'".(($_POST['Country'] == 'Micronesia') ? "selected" : "").">Micronesia</option><option value='Moldova'".(($_POST['Country'] == 'Moldova') ? "selected" : "").">Moldova</option><option value='Monaco'".(($_POST['Country'] == 'Monaco') ? "selected" : "").">Monaco</option><option value='Mongolia'".(($_POST['Country'] == 'Mongolia') ? "selected" : "").">Mongolia</option><option value='Montserrat'".(($_POST['Country'] == 'Montserrat') ? "selected" : "").">Montserrat</option><option value='Morocco'".(($_POST['Country'] == 'Morocco') ? "selected" : "").">Morocco</option><option value='Mozambique'".(($_POST['Country'] == 'Mozambique') ? "selected" : "").">Mozambique</option><option value='Myanmar'".(($_POST['Country'] == 'Myanmar') ? "selected" : "").">Myanmar</option><option value='Namibia'".(($_POST['Country'] == 'Namibia') ? "selected" : "").">Namibia</option><option value='Nauru'".(($_POST['Country'] == 'Nauru') ? "selected" : "").">Nauru</option><option value='Nepal'".(($_POST['Country'] == 'Nepal') ? "selected" : "").">Nepal</option><option value='Netherlands'".(($_POST['Country'] == 'Netherlands') ? "selected" : "").">Netherlands</option><option value='Netherlands Antilles'".(($_POST['Country'] == 'Netherlands Antilles') ? "selected" : "").">Netherlands Antilles</option><option value='New Caledonia'".(($_POST['Country'] == 'New Caledonia') ? "selected" : "").">New Caledonia</option><option value='New Zealand'".(($_POST['Country'] == 'New Zealand') ? "selected" : "").">New Zealand</option><option value='Nicaragua'".(($_POST['Country'] == 'Nicaragua') ? "selected" : "").">Nicaragua</option><option value='Niger'".(($_POST['Country'] == 'Niger') ? "selected" : "").">Niger</option><option value='Nigeria'".(($_POST['Country'] == 'Nigeria') ? "selected" : "").">Nigeria</option><option value='Niue'".(($_POST['Country'] == 'Niue') ? "selected" : "").">Niue</option><option value='Norfolk Island'".(($_POST['Country'] == 'Norfolk Island') ? "selected" : "").">Norfolk Island</option><option value='Northern Mariana Islands'".(($_POST['Country'] == 'Northern Mariana Islands') ? "selected" : "").">Northern Mariana Islands</option><option value='Norway'".(($_POST['Country'] == 'Norway') ? "selected" : "").">Norway</option><option value='Oman'".(($_POST['Country'] == 'Oman') ? "selected" : "").">Oman</option><option value='Pakistan'".(($_POST['Country'] == 'Pakistan') ? "selected" : "").">Pakistan</option><option value='Palau'".(($_POST['Country'] == 'Palau') ? "selected" : "").">Palau</option><option value='Panama'".(($_POST['Country'] == 'Panama') ? "selected" : "").">Panama</option><option value='Papua New Guinea'".(($_POST['Country'] == 'Papua New Guinea') ? "selected" : "").">Papua New Guinea</option><option value='Paraguay'".(($_POST['Country'] == 'Paraguay') ? "selected" : "").">Paraguay</option><option value='Peru'".(($_POST['Country'] == 'Peru') ? "selected" : "").">Peru</option><option value='Philippines'".(($_POST['Country'] == 'Philippines') ? "selected" : "").">Philippines</option><option value='Pitcairn'".(($_POST['Country'] == 'Pitcairn') ? "selected" : "").">Pitcairn</option><option value='Poland'".(($_POST['Country'] == 'Poland') ? "selected" : "").">Poland</option><option value='Portugal'".(($_POST['Country'] == 'Portugal') ? "selected" : "").">Portugal</option><option value='Puerto Rico'".(($_POST['Country'] == 'Puerto Rico') ? "selected" : "").">Puerto Rico</option><option value='Qatar'".(($_POST['Country'] == 'Qatar') ? "selected" : "").">Qatar</option><option value='Reunion'".(($_POST['Country'] == 'Reunion') ? "selected" : "").">Reunion</option><option value='Romania'".(($_POST['Country'] == 'Romania') ? "selected" : "").">Romania</option><option value='Russian Federation'".(($_POST['Country'] == 'Russian Federation') ? "selected" : "").">Russian Federation</option><option value='Rwanda'".(($_POST['Country'] == 'Rwanda') ? "selected" : "").">Rwanda</option><option value='Saint Kitts And Nevis'".(($_POST['Country'] == 'Saint Kitts And Nevis') ? "selected" : "").">Saint Kitts And Nevis</option><option value='Saint Lucia'".(($_POST['Country'] == 'Saint Lucia') ? "selected" : "").">Saint Lucia</option><option value='Saint Vincent And The Grenadines'".(($_POST['Country'] == 'Saint Vincent And The Grenadines') ? "selected" : "").">Saint Vincent And The Grenadines</option><option value='Samoa'".(($_POST['Country'] == 'Samoa') ? "selected" : "").">Samoa</option><option value='San Marino'".(($_POST['Country'] == 'San Marino') ? "selected" : "").">San Marino</option><option value='Sao Tome And Principe'".(($_POST['Country'] == 'Sao Tome And Principe') ? "selected" : "").">Sao Tome And Principe</option><option value='Saudi Arabia'".(($_POST['Country'] == 'Saudi Arabia') ? "selected" : "").">Saudi Arabia</option><option value='Senegal'".(($_POST['Country'] == 'Senegal') ? "selected" : "").">Senegal</option><option value='Seychelles'".(($_POST['Country'] == 'Seychelles') ? "selected" : "").">Seychelles</option><option value='Sierra Leone'".(($_POST['Country'] == 'Sierra Leone') ? "selected" : "").">Sierra Leone</option><option value='Singapore'".(($_POST['Country'] == 'Singapore') ? "selected" : "").">Singapore</option><option value='Slovakia'".(($_POST['Country'] == 'Slovakia') ? "selected" : "").">Slovakia</option><option value='Slovenia'".(($_POST['Country'] == 'Slovenia') ? "selected" : "").">Slovenia</option><option value='Solomon Islands'".(($_POST['Country'] == 'Solomon Islands') ? "selected" : "").">Solomon Islands</option><option value='Somalia'".(($_POST['Country'] == 'Somalia') ? "selected" : "").">Somalia</option><option value='South Africa'".(($_POST['Country'] == 'South Africa') ? "selected" : "").">South Africa</option><option value='South Georgia And The South Sandwich Islands'".(($_POST['Country'] == 'South Georgia And The South Sandwich Islands') ? "selected" : "").">South Georgia And The South Sandwich Islands</option><option value='Spain'".(($_POST['Country'] == 'Spain') ? "selected" : "").">Spain</option><option value='Sri Lanka'".(($_POST['Country'] == 'Sri Lanka') ? "selected" : "").">Sri Lanka</option><option value='St Helena'".(($_POST['Country'] == 'St Helena') ? "selected" : "").">St Helena</option><option value='St Pierre and Miquelon'".(($_POST['Country'] == 'St Pierre and Miquelon') ? "selected" : "").">St Pierre and Miquelon</option><option value='Sudan'".(($_POST['Country'] == 'Sudan') ? "selected" : "").">Sudan</option><option value='Suriname'".(($_POST['Country'] == 'Suriname') ? "selected" : "").">Suriname</option><option value='Svalbard And Jan Mayen Islands'".(($_POST['Country'] == 'Svalbard And Jan Mayen Islands') ? "selected" : "").">Svalbard And Jan Mayen Islands</option><option value='Swaziland'".(($_POST['Country'] == 'Swaziland') ? "selected" : "").">Swaziland</option><option value='Sweden'".(($_POST['Country'] == 'Sweden') ? "selected" : "").">Sweden</option><option value='Switzerland'".(($_POST['Country'] == 'Switzerland') ? "selected" : "").">Switzerland</option><option value='Syrian Arab Republic'".(($_POST['Country'] == 'Syrian Arab Republic') ? "selected" : "").">Syrian Arab Republic</option><option value='Taiwan'".(($_POST['Country'] == 'Taiwan') ? "selected" : "").">Taiwan</option><option value='Tajikistan'".(($_POST['Country'] == 'Tajikistan') ? "selected" : "").">Tajikistan</option><option value='Tanzania'".(($_POST['Country'] == 'Tanzania') ? "selected" : "").">Tanzania</option><option value='Thailand'".(($_POST['Country'] == 'Thailand') ? "selected" : "").">Thailand</option><option value='Togo'".(($_POST['Country'] == 'Togo') ? "selected" : "").">Togo</option><option value='Tokelau'".(($_POST['Country'] == 'Tokelau') ? "selected" : "").">Tokelau</option><option value='Tonga'".(($_POST['Country'] == 'Tonga') ? "selected" : "").">Tonga</option><option value='Trinidad And Tobago'".(($_POST['Country'] == 'Trinidad And Tobago') ? "selected" : "").">Trinidad And Tobago</option><option value='Tunisia'".(($_POST['Country'] == 'Tunisia') ? "selected" : "").">Tunisia</option><option value='Turkey'".(($_POST['Country'] == 'Turkey') ? "selected" : "").">Turkey</option><option value='Turkmenistan'".(($_POST['Country'] == 'Turkmenistan') ? "selected" : "").">Turkmenistan</option><option value='Turks And Caicos Islands'".(($_POST['Country'] == 'Turks And Caicos Islands') ? "selected" : "").">Turks And Caicos Islands</option><option value='Tuvalu'".(($_POST['Country'] == 'Tuvalu') ? "selected" : "").">Tuvalu</option><option value='Uganda'".(($_POST['Country'] == 'Uganda') ? "selected" : "").">Uganda</option><option value='Ukraine'".(($_POST['Country'] == 'Ukraine') ? "selected" : "").">Ukraine</option><option value='United Arab Emirates'".(($_POST['Country'] == 'United Arab Emirates') ? "selected" : "").">United Arab Emirates</option><option value='United Kingdom'".(($_POST['Country'] == 'United Kingdom') ? "selected" : "").">United Kingdom</option><option value='United States'".(($_POST['Country'] == 'United States') ? "selected" : "").">United States</option><option value='United States Minor Outlying Islands'".(($_POST['Country'] == 'United States Minor Outlying Islands') ? "selected" : "").">United States Minor Outlying Islands</option><option value='Uruguay'".(($_POST['Country'] == 'Uruguay') ? "selected" : "").">Uruguay</option><option value='Uzbekistan'".(($_POST['Country'] == 'Uzbekistan') ? "selected" : "").">Uzbekistan</option><option value='Vanuatu'".(($_POST['Country'] == 'Vanuatu') ? "selected" : "").">Vanuatu</option><option value='Vatican City State'".(($_POST['Country'] == 'Vatican City State') ? "selected" : "").">Vatican City State</option><option value='Venezuela'".(($_POST['Country'] == 'Venezuela') ? "selected" : "").">Venezuela</option><option value='Viet Nam'".(($_POST['Country'] == 'Viet Nam') ? "selected" : "").">Viet Nam</option><option value='Virgin Islands (British)'".(($_POST['Country'] == 'Virgin Islands (British)') ? "selected" : "").">Virgin Islands (British)</option><option value='Virgin Islands (U.S.)'".(($_POST['Country'] == 'Virgin Islands (U.S.)') ? "selected" : "").">Virgin Islands (U.S.)</option><option value='Wallis And Futuna Islands'".(($_POST['Country'] == 'Wallis And Futuna Islands') ? "selected" : "").">Wallis And Futuna Islands</option><option value='Western Sahara'".(($_POST['Country'] == 'Western Sahara') ? "selected" : "").">Western Sahara</option><option value='Yemen'".(($_POST['Country'] == 'Yemen') ? "selected" : "").">Yemen</option><option value='Zaire'".(($_POST['Country'] == 'Zaire') ? "selected" : "").">Zaire</option><option value='Zambia'".(($_POST['Country'] == 'Zambia') ? "selected" : "").">Zambia</option><option value='Zimbabwe'".(($_POST['Country'] == 'Zimbabwe') ? "selected" : "").">Zimbabwe</option><option value='Other - Not Shown'".(($_POST['Country'] == 'Other - Not Shown') ? "selected" : "").">Other - Not Shown</option></select></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>"; $questionblock = "<tr><td colspan=2><input type='checkbox' class=clear name='MAID:0000004862' value='0000053100' ".(($_POST['MAID:0000004862'] == '0000053100') ? "checked='checked'":"")." /><b>Yes, I have verified this is my current postal mailing address.</b>$reqsymbol</td></tr> "; $thanksTitle = 'Thank You'; $thanksHeader = 'Thanks for your time!'; $thanksText = '<P>Many thanks for your interest in the latest Hatteras Realty brochure. You can expect to see it in your mailbox this fall. We appreciate your business and will do our best to serve your needs! </p>';

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