PHP - Program An Online Calculator

<?php
//this is the isset function which allows us to submit back
//to the same form.  If there isn't anything in the ISBN, it will
//show the bottom part of the form
if(isset($_POST["ISBN"])|| empty($_POST['isbn_type']) 
	|| empty($_POST['Valid_Invalid']))
{
	$ISBN = $_POST["ISBN"];;
	$IsbnType = $_POST["isbn_type"];;
	$VaorIn = $_POST["Valid_Invalid"];;

	$ISBN_Arr = str_split($ISBN);
	$not10 =0;
	$notNum=0;
	$notX=0;
	//entering error checking for the code
	//check for 10 first, if clear do additional checking
	if(strlen($ISBN) == 10)
		{//start further error checking	
		//check to make sure first 9 are numeric
		for($i=0;$i<=8;$i++)
			{
			if(!is_numeric($ISBN_Arr[$i]))
				$notNum = 1;
			}//end for loop check
		//check to see if there is a X or a x
		if($ISBN_Arr[9]=='x' || $ISBN_Arr[9]=='X')
			{
				$ISBN_Arr[9] = 10;
			}
			//if not an x, is it at least numeric?
			else if (!is_numeric($ISBN_Arr[9]) )
			{
				$notX=1;
			}
		}//end additional error checking 
		else {
			$not10=1;	
			}//end not 10 check
	//start of error messages if prereqs are not met			
	if($notNum ==1 || $notX ==1 || $not10)
		{
		Print "<h2>Input error</h2><br/>";
		Print "Here is the error(s) discovered:<br/>";
		if($notNum ==1)
			print"Your ISBN contains non-numeric data.<br/>";
		if($notX ==1)
			print"The last digit is not a number or a X.<br/>";
		if($not10 ==1)
			print"ISBN 10 number should contain 10 characters.<br/>";
				
		include"ISBN_not_val_include.html";
		}
	//end error checking
	else{
		$chk_sum_num=10;
		$chk_sum =0;
		for($i=0;$i<=9;$i++)
		{
			$chk_sum +=$ISBN_Arr[$i] *$chk_sum_num;
				//print"$ISBN_Arr[$i] | $chk_sum_num<br/>";
			$chk_sum_num--;
		}//end for loop
		$is_valid_ISBN= $chk_sum%11;
		//print"chk_sum: $chk_sum </br> is_valid_ISBN: $is_valid_ISBN</br>";
		if($is_valid_ISBN==0)
			{
			print"<h3>VALID</h3><br/>";
			print"$ISBN is a VALID 10 digit ISBN number.<br/>";
			include"ISBN_val_include.html";
			}
			else{
			print"<h3>INVALID</h3><br/>";
			print"$ISBN is an INVALID 10 number ISBN.<br/>";
			include"ISBN_not_val_include.html";
			}//end is_valid if
		}//end
	}//end is set if
	else{
	include"ISBN_val_include.html";
}//end isset else
?>


</form>
<p><a href="_ShowISBN10and13DBProject.php">Show ISBN 
</a></p> 


</body>
</html>

<?php

if (empty($_POST['ISBN'])|| empty($_POST['isbn_type']) 
	|| empty($_POST['Valid_Invalid']))
	
	echo "<p>You must enter a Valid ISBN 10 to Continue! 
		 Please Click your browser's Back Button to return 
		 to the input page of ISBN 10 with Database.</p>\n";
		 
else {
	$DBConnect = @mysql_connect("xxx.xxx.xx.xxx", "xxxxxxxx", "xxxxxxxx");
	if($DBConnect === false)
		echo"<p>Unable to conenct to the database server.</p>"
		. "<p>Error code " . mysql_errno()
		. ": " . mysql_error() . "</p>";
	else{
	$DBName = "xxxxxxxx";
	if (!@mysql_select_db($DBName, $DBConnect)) {
		$SQLstring = "CREATE DATABASE $DBName";
		$QueryResult = @mysql_query($SQLstring,
		$DBConnect);
		
		if ($QueryResult === FALSE)
		echo "<p>Unable to execute the query.</p>"
		. "<p>Error code " . mysql_errno($DBConnect)
		. ": " . mysql_error($DBConnect) . "</p>";
	else 
		echo "<p>You are the first visitor!</p>";
	}
	mysql_select_db($DBName, $DBConnect);
	
	$TableName = "isbn";
	$SQLstring = "SHOW TABLES LIKE '$TableName'";
	$QueryResult = @mysql_query($SQLstring, $DBConnect);
	
	
	
	if ($QueryResult === FALSE) 
		echo "<p>Unable to create the table.</p>"
		. "<p>Error code " . mysql_errno($DBConnect)
		. ": " . mysql_error($DBConnect) . "</p>";
		
	$ISBNum = stripslashes($_POST['ISBN']);
	$ISBNType = stripslashes($_POST['isbn_type']);
	$VaORIn = stripslashes($_POST['Valid_Invalid']);
	$SQLstring = "INSERT INTO $TableName 
	VALUES(NULL, '$ISBNum', '$ISBNType', 
	'$VaORIn')";
	$QueryResult = @mysql_query($SQLstring, $DBConnect);
		
		if($QueryResult === false)
			echo"<p>Unable to execute the query.</p>"
			. "<p>Error code " . mysql_errno($DBConnect)
			. ": " . mysql_error($DBConnect) . "</p>";
		else
			echo"<h1>Thank you for trying our ISBN 10 program!</h1>";	
	
	
	mysql_close($DBConnect);
	}
}
	
	


?><!--End PHP Script-->

<?php

	$DBConnect = @mysql_connect("xxx.xxx.xx.xxx", "xxxxxxx", "xxxxx");
	if($DBConnect === false)
		echo"<p>Unable to conenct to the database server.</p>"
		. "<p>Error code " . mysql_errno()
		. ": " . mysql_error() . "</p>";
	else{
		$DBName = "xxxxxx";
	if (!@mysql_select_db($DBName, $DBConnect))
		echo"<p>There are no entries in the guest book!</p>";
	else {
	$TableName = "isbn";
	$SQLstring = "SELECT * FROM $TableName";
	$QueryResult = @mysql_query($SQLstring, $DBConnect);
	
	if (mysql_num_rows($QueryResult) == 0) 
		echo"<p>There are no entries in the ISBN 10 Database!</p>";
	else{
		echo"<p>The following ISBN have 
		been recorded:</p>";
		echo"<table width='100%' border='1'>";
		echo"<tr><th>ISBN Number</th><th>ISBN Type</th><th>
			Date Entred</th><th>
			Valid OR Invalid</th></tr>";
		while (($Row = mysql_fetch_assoc($QueryResult)) !==FALSE) {
			echo "<tr><td>{$Row['ISBN']}</td>";
			echo "<tr><td>{$Row['isbn_type']}</td>";
			echo "<tr><td>{$Row['TIMESTAMP']}</td>";
			echo "<td>{$Row['Valid_Invalid']}</td></tr>";
			
			}
			
		}
		mysql_free_result($QueryResult);
	}
	mysql_close($DBConnect);
}
	
		

<?php // login.php
// Get connection information

echo <<<_END
    <form method = "post" action = "login.php">
    <pre>
    <input type = "text" name = "localhost" />host server<br />
    <input type = "text" name = "username" />Username<br />
    <input type = "text" name = "password" /><br />
    <br />
    <input type = "submit" value = "submit" />
    </form>
_END

$db_server = sanitize_string($localhost);
$db_username = sanitize_string($username);
$db_password = sanitize_string($password);

/*
$user = 'root';
$password = 'root';
$db = 'rpsls';
$host = 'localhost';
$port = 3306;

$link = mysql_connect(
"$host:$port",
$user,
$password
);
$db_selected = mysql_select_db(
$db,
$link
);
*/

mysql_connect($db_server, $db_username, $db_password) or die(mysql_error());

// Create rpsls table if it does not exist

$tbl = "rpsls";
$query = "CREATE TABLE rpsls(human VARCHAR(10), computer VARCHAR(10), outcome VARCHAR(5),
    action VARCHAR(15));

INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Rock", "Paper", "Lose", "Covers");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Rock", "Scissors", "Win", "Crushes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Rock", "Lizard", "Win", "Crushes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Rock", "Spock", "Lose", "Vaporizes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Paper", "Rock", "Win", "Covers");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Paper", "Scissors", "Lose", "Cuts");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Paper", "Lizard", "Lose", "Eats");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Paper", "Spock", "Win", "Disproves");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Scissors", "Lizard", "Win", "Decapitates");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Scissors", "Spock", "Lose", "Smashes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Scissors", "Rock", "Lose", "Crushes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Scissors", "Paper", "Win", "Cuts");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Lizard", "Spock", "Win", "Poisons");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Lizard", "Rock", "Lose", "Crushes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Lizard", "Paper", "Win", "Eats");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Lizard", "Scissors", "Lose", "Decapitates");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Spock", "Rock", "Win", "Vaporizes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Spock", "Paper", "Lose", "Disproves");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Spock", "Scissors", "Win", "Smashes");
INSERT INTO rpsls (human, computer, outcome, action) VALUES ("Spock", "Lizard", "Lose", "Poisons");";

check_table($tbl, $query);

// Create choices table if it does not exist

$tbl = "choices";

$query = "CREATE TABLE choices(id SMALLINT, choice VARCHAR(10));

INSERT INTO choices (id, choice) VALUES (1, "Rock");
INSERT INTO choices (id, choice) VALUES (2, "Paper");
INSERT INTO choices (id, choice) VALUES (3, "Scissors");
INSERT INTO choices (id, choice) VALUES (4, "Lizard");
INSERT INTO choices (id, choice) VALUES (5, "Spock");";

check_table($tbl, $query);

// Sanitize user input

function sanitize_string($var)
{
$var = stripslashes($var);
$var = htmlentities($var);
$var = strip_tags($var);
return $var;
}

function check_table($tbl, $query){

$db = new mysqli(...);
$result = $db->query("SHOW TABLES LIKE "$tbl);
if ($result->num_rows == 0){
    mysql_query($query);
    }
}

?>

<?php

// log into server and database

require_once 'login.php';
$db_server = mysql_connect($db_hostname, $db_username, $db_password);
if (!$db_server) die("Unable to connect to MySQL: " . mysql_error());
$conn = mysql_connect($db_server, $db_username, $db_password) or die(mysql_error());
$db_database = 'rpsls';
mysql_select_db($db_database) or die("Unable to select database: " . mysql_error());

// Start Game

ready_to_play();


// Rock Paper Scissors Lizard Spock game
function rock_paper_scissors_lizard_spock()
{
$human = human_play();
$computer = computer_play();
game_outcome($human, $computer);
play_again();


// Start Game Function

function ready_to_play(){
echo <<<_END
    <form method = "post" action = "rpsls.php">
    <h2>Ready to play Rock, Paper, Lizard, Spock?</h2>
    <hr>
    <table>
    <tr>
        <td><input type = "radio" name = "ready" value = "Yes" />Yes</td>
        <td><input type = "radio" name = "ready" value = "No" />No</td>
    </tr>
        <tr>
        <td colspan = "2"><input type = "submit" value = "Play!" /></td>
    </tr>
    </table>
    </form>
_END
    
    if ($ready == "Yes"){
        $query = "CREATE TABLE gameResults (
            games SMALLINT NOT NULL,
            win SMALLINT NULL,
            loss SMALLINT NULL,
            draw SMALLINT NULL,
            PRIMARY KEY (games))";
            
        mysql_query($query);    
        
        rock_paper_scissors_lizard_spock();
    }else{
        close_rpsls();
    }
}

// Play Again

// Start Game Function

function play_again()
{
echo <<<_END
    <form method = "post" action = "rpsls.php">
    <h2>Play Again?</h2>
    <hr>
    <table>
    <tr>
        <td><input type = "radio" name = "ready" value = "Yes" />Yes</td>
        <td><input type = "radio" name = "ready" value = "No" />No</td>
    </tr>
        <tr>
        <td colspan = "2"><input type = "submit" value = "Play!" /></td>
    </tr>
    </table>
    </form>
_END
    
    if ($ready == "Yes"){
        rock_paper_scissors_lizard_spock();
    }else{
        close_rpsls();
    }
}

// Human Play Selection

function human_play()
{
echo <<<_END
    <form method = "post" action = "rpsls.php">
    <h2>Let's Play Rock, Paper, Lizard, Spock</h2>
    <hr>
    <table>
    <tr>
        <td><input type = "radio" name = "human" value = "Rock" />Rock</td>
        <td><input type = "radio" name = "human" value = "Paper" />Paper</td>
    </tr>
    <tr>
        <td><input type = "radio" name = "human" value = "Scissors" />Scissors</td>
        <td><input type = "radio" name = "human" value = "Lizard" />Lizard</td>
    </tr>
    <tr>
        <td colspan = "2"><input type = "radio" name = "human" value = "Spock" />Spock</td>
    </tr>
    <tr>
        <td colspan = "2"><hr></td>
    </tr>
    <tr>
        <td colspan = "2"><input type = "submit" value = "Play!" /></td>
    </tr>
    </table>
    </form>
    
_END
    
    return $human;
}

// Computer Play Selection

function computer_play()
{
    $play = rand(1,5);
    $query = "SELECT choice FROM choices WHERE number = $play";
    $computer = mysql_query($query);
    
    return $computer;
}

// Game Outcome Function

function game_outcome($human, $computer)
{
    $win = $loss = $draw = 0
    
    if ($human == $computer){
        echo "Draw<br />";
        echo "We both played ".$human;
        $draw = 1;
    }else{
        $query = "SELECT outcome, action FROM rpsls WHERE human = $human AND computer = $computer";
        $results = mysql_query($query);
        $results2 = mysql_fetch_array($results);
        $outcome = $results2[0];
        $action = $results2[1];
        
        if ($outcome == "Win"{
            echo "You Win!!!<br />"
            echo "Your ".$human. " ".$action." my ".$computer."<br />";
            $win = 1;
        }else{
            echo "You Lose/.<br />
            echo "My ".$computer." ".$action." your ".$human."<br />";
            $loss = 1;
            }
        }
        $query = "INSERT INTO gameResults VALUES".(NULL, '$win', '$loss', '$draw')";
        mysql_query($query);
}

// Game Statistics Function

function game_statistics ()
{
    $query = "SELECT * FROM gameResults";
    $result = mysql_query($query);
    $rows = mysql_num_rows($result);
    $games = $rows;
    $win = $loss = $draw = 0;
    
    for ($index = 0; $index < $rows; ++$index){
        $row = mysql_fetch_row($result);
        $win = $win + $row[1];
        $loss = $loss + $row[2];
        $draw = $draw + $row[3];
    }
    
echo <<<_END
    <table>
    <tr>
        <td>Games</td>
        <td>Win</td>
        <td>Loss</td>
        <td>Draw</td>
    </tr>
    <tr>
        <td>$games</td>
        <td>$win</td>
        <td>$loss</td>
        <td>$draw</td>
    </tr>
    </table>
_END
}

// Print Statistics and close the game

function close_rpsls(){
echo <<<_END
    <form method = "post" action = "rpsls.php">
    <h3>Are you sure you want to quit?</h3>
    <hr>
    <table>
    <tr>
        <td><input type = "radio" name = "ready" value = "Yes" />Yes</td>
        <td><input type = "radio" name = "ready" value = "No" />No</td>
    </tr>
        <tr>
        <td colspan = "2"><input type = "submit" value = "Play!" /></td>
    </tr>
    </table>
    </form>
_END
    
    if ($ready == "No"){
        rock_paper_scissors_lizard_spock();
    }else{
        $query = "DROP TABLE gameResults";
        mysql_query($query);
    }    
}

// close connection
mysql_close($conn);
?>

<?php

    session_start();
    
    function getRealIp() {
       if (!empty($_SERVER['HTTP_CLIENT_IP'])) {  //check ip from share internet
         $ip=$_SERVER['HTTP_CLIENT_IP'];
       } elseif (!empty($_SERVER['HTTP_X_FORWARDED_FOR'])) {  //to check ip is pass from proxy
         $ip=$_SERVER['HTTP_X_FORWARDED_FOR'];
       } else {
         $ip=$_SERVER['REMOTE_ADDR'];
       }
       return $ip;
    }

    function writeLog($where) {
    
    	$ip = getRealIp(); // Get the IP from superglobal
    	$host = gethostbyaddr($ip);    // Try to locate the host of the attack
    	$date = date("d M Y");
    	
    	// create a logging message with php heredoc syntax
    	$logging = <<<LOG
    		\n
    		<< Start of Message >>
    		There was a hacking attempt on your form. \n 
    		Date of Attack: {$date}
    		IP-Adress: {$ip} \n
    		Host of Attacker: {$host}
    		Point of Attack: {$where}
    		<< End of Message >>
LOG;
// Awkward but LOG must be flush left
    
            // open log file
    		if($handle = fopen('hacklog.log', 'a')) {
    		
    			fputs($handle, $logging);  // write the Data to file
    			fclose($handle);           // close the file
    			
    		} else {  // if first method is not working, for example because of wrong file permissions, email the data
    		
    			$to = 'aserio@damageana.com';  
            	$subject = 'HACK ATTEMPT';
            	$header = 'From: aserio@damageana.com';
            	if (mail($to, $subject, $logging, $header)) {
            		echo "Sent notice to admin.";
            	}
    
    		}
    }

    function verifyFormToken($form) {
        
        // check if a session is started and a token is transmitted, if not return an error
    	if(!isset($_SESSION[$form.'_token'])) { 
    		return false;
        }
    	
    	// check if the form is sent with token in it
    	if(!isset($_POST['token'])) {
    		return false;
        }
    	
    	// compare the tokens against each other if they are still the same
    	if ($_SESSION[$form.'_token'] !== $_POST['token']) {
    		return false;
        }
    	
    	return true;
    }
    
    function generateFormToken($form) {
    
        // generate a token from an unique value, took from microtime, you can also use salt-values, other crypting methods...
    	$token = md5(uniqid(microtime(), true));  
    	
    	// Write the generated token to the session variable to check it against the hidden field when the form is sent
    	$_SESSION[$form.'_token'] = $token; 
    	
    	return $token;
    }
    
    // VERIFY LEGITIMACY OF TOKEN
    if (verifyFormToken('form1')) {
    
        // CHECK TO SEE IF THIS IS A MAIL POST
        if (isset($_POST['req-name'])) {
        
            // Building a whitelist array with keys which will send through the form, no others would be accepted later on
            $whitelist = array('token','req-company','req-email','req-name','req-phone','ext','fax','assign_type','loss_type','req-claim','policy','ded','dol','Clmt-Own','insd','insd_add','insd_city','insd_st','insd-zip','insd-home','insd-work','insd-cell','insd-other','clmt','clmt_add','clmt_city','clmt_st','clmt-zip','clmt-home','clmt-work','clmt-cell','clmt-other','VIN','veh-year','veh-make','veh-model','veh-model','veh-color','lic_pl','location','loc-name','loc-add','loc-city','loc-st','loc-zip','loc-con','loc-phone','desc-loss','desc-dmg','spec-inst','save-company','save-email','save-name','save-phone');
            
            // Building an array with the $_POST-superglobal 
            foreach ($_POST as $key=>$item) {
                    
                    // Check if the value $key (fieldname from $_POST) can be found in the whitelisting array, if not, die with a short message to the hacker
            		if (!in_array($key, $whitelist)) {
            			
            			writeLog('Unknown form fields');
            			die("Hack-Attempt detected. Please use only the fields in the form");
            			
            		}
            }
            
            // SAVE INFO AS COOKIE, if user wants name and email saved
            
            $saveCompany = $_POST['save-company'];
            if ($saveCompany == 'on') {
                setcookie("NA-Company", $_POST['req-company'], time()+60*60*24*365);
                }
                
            $saveName = $_POST['save-name'];
            if ($saveName == 'on') {
                setcookie("NA-Name", $_POST['req-name'], time()+60*60*24*365);
                }
                
            $saveEmail = $_POST['save-email'];
            if ($saveEmail =='on') {
                setcookie("NA-Email", $_POST['req-email'], time()+60*60*24*365);
            }
            
            $savePhone = $_POST['save-phone'];
            if ($savePhone =='on') {
	            setcookie("NA-Phone", $_POST['req-phone'], time()+60*60*24*365);
            }
            
            
            
            // PREPARE THE BODY OF THE MESSAGE

			$message = '<html><body>';
			$message .= '<img src="http://www.damageana.com/images/DANA_NA_header.png" alt="Assignment Request" />';
			$message .= '<table rules="all" style="border-color: #666;" cellpadding="10">';
			$message .= "<tr style='background: #eee;'><td><strong>Company:</strong> </td><td>" . strip_tags($_POST['req-company']) . "</td></tr>";
			$message .= "<tr><td><strong>Adjuster:</strong> </td><td>" . strip_tags($_POST['req-name']) . "</td></tr>";
			$message .= "<tr><td><strong>Email:</strong> </td><td>" . strip_tags($_POST['req-email']) . "</td></tr>";
			$message .= "<tr><td><strong>Phone:</strong> </td><td>" . strip_tags($_POST['req-phone']) . "</td></tr>";
			if($_POST['ext'] !='') {$message .= "<tr><td><strong>Extension:</strong> </td><td>" . strip_tags($_POST['ext']) . "</td></tr>";}
			if($_POST['fax'] !='') {$message .= "<tr><td><strong>Fax:</strong> </td><td>" . strip_tags($_POST['fax']) . "</td></tr>";}
			$message .= "<tr><td><strong>Assignment Type:</strong> </td><td>" . strip_tags($_POST['assign_type']) . "</td></tr>";
			if($_POST['loss_type'] !='') {$message .= "<tr><td><strong>Type of Loss:</strong> </td><td>" . strip_tags($_POST['loss_type']) . "</td></tr>";}
			$message .= "<tr><td><strong>Claim #:</strong> </td><td>" . strip_tags($_POST['req-claim']) . "</td></tr>";
			if($_POST['policy'] !='') {$message .= "<tr><td><strong>Policy #:</strong> </td><td>" . strip_tags($_POST['policy']) . "</td></tr>";}
			if($_POST['ded'] !='') {$message .= "<tr><td><strong>Deductible:</strong> </td><td> $" . strip_tags($_POST['ded']) . "</td></tr>";}
			if($_POST['dol'] !='') {$message .= "<tr><td><strong>Date of Loss:</strong> </td><td>" . strip_tags($_POST['dol']) . "</td></tr>";}
			if($_POST['insd'] !='') {$message .= "<tr><td><strong>Insured:</strong> </td><td>" . strip_tags($_POST['insd']) . "</td></tr>";}
			if($_POST['insd_add'] !='') {$message .= "<tr><td><strong>Insured's Address:</strong> </td><td>" . strip_tags($_POST['insd_add']) . "</td></tr>";}
			if($_POST['insd_city'] !='') {$message .= "<tr><td><strong>Insured's City:</strong> </td><td>" . strip_tags($_POST['insd_city']) . "</td></tr>";}
			if($_POST['insd_st'] !='') {$message .= "<tr><td><strong>Insured's State:</strong> </td><td>" . strip_tags($_POST['insd_st']) . "</td></tr>";}
			if($_POST['insd-zip'] !='') {$message .= "<tr><td><strong>Insured's Zip:</strong> </td><td>" . strip_tags($_POST['insd-zip']) . "</td></tr>";}
			if($_POST['insd-home'] !='') {$message .= "<tr><td><strong>Insured's Home Phone:</strong> </td><td>" . strip_tags($_POST['insd-home']) . "</td></tr>";}
			if($_POST['insd-work'] !='') {$message .= "<tr><td><strong>Insured's Work Phone:</strong> </td><td>" . strip_tags($_POST['insd-work']) . "</td></tr>";}
			if($_POST['insd-cell'] !='') {$message .= "<tr><td><strong>Insured's Mobile Phone:</strong> </td><td>" . strip_tags($_POST['insd-cell']) . "</td></tr>";}
			if($_POST['insd-other'] !='') {$message .= "<tr><td><strong>Insured's Other Phone:</strong> </td><td>" . strip_tags($_POST['insd-other']) . "</td></tr>";}
			if($_POST['clmt'] !='') {$message .= "<tr><td><strong>Claimant:</strong> </td><td>" . strip_tags($_POST['clmt']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Address:</strong> </td><td>" . strip_tags($_POST['clmt_add']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's City:</strong> </td><td>" . strip_tags($_POST['clmt_city']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's State:</strong> </td><td>" . strip_tags($_POST['clmt_st']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Zip:</strong> </td><td>" . strip_tags($_POST['clmt-zip']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Home Phone:</strong> </td><td>" . strip_tags($_POST['clmt-home']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Work Phone:</strong> </td><td>" . strip_tags($_POST['clmt-work']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Mobile Phone:</strong> </td><td>" . strip_tags($_POST['clmt-cell']) . "</td></tr>";
			$message .= "<tr><td><strong>Claimant's Other Phone:</strong> </td><td>" . strip_tags($_POST['clmt-other']) . "</td></tr>";}
			if($_POST['VIN'] !='') {$message .= "<tr><td><strong>VIN:</strong> </td><td>" . strip_tags($_POST['VIN']) . "</td></tr>";}
			if($_POST['veh-year'] !='') {$message .= "<tr><td><strong>Year:</strong> </td><td>" . strip_tags($_POST['veh-year']) . "</td></tr>";}
			if($_POST['veh-make'] !='') {$message .= "<tr><td><strong>Make:</strong> </td><td>" . strip_tags($_POST['veh-make']) . "</td></tr>";}
			if($_POST['veh-model'] !='') {$message .= "<tr><td><strong>Model:</strong> </td><td>" . strip_tags($_POST['veh-model']) . "</td></tr>";}
			if($_POST['veh-color'] !='') {$message .= "<tr><td><strong>Color:</strong> </td><td>" . strip_tags($_POST['veh-color']) . "</td></tr>";}
			if($_POST['lic_pl'] !='') {$message .= "<tr><td><strong>License Plate:</strong> </td><td>" . strip_tags($_POST['lic_pl']) . "</td></tr>";}
			$message .= "<tr><td><strong>Unit Location:</strong> </td><td>" . strip_tags($_POST['location']) . "</td></tr>";
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location Name:</strong> </td><td>" . strip_tags($_POST['loc-name']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location Address:</strong> </td><td>" . strip_tags($_POST['loc-add']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location City:</strong> </td><td>" . strip_tags($_POST['loc-city']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location State:</strong> </td><td>" . strip_tags($_POST['loc-st']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location Zip:</strong> </td><td>" . strip_tags($_POST['loc-zip']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location Contact:</strong> </td><td>" . strip_tags($_POST['loc-con']) . "</td></tr>";}
			if($_POST['location'] =='At Another Location') {$message .= "<tr><td><strong>Location Phone:</strong> </td><td>" . strip_tags($_POST['loc-phone']) . "</td></tr>";}
			if($_POST['desc-loss'] !='') {$message .= "<tr><td><strong>Description of Loss:</strong> </td><td>" . htmlentities($_POST['desc-loss']) . "</td></tr>";}
			if($_POST['desc-dmg'] !='') {$message .= "<tr><td><strong>Description of Damage:</strong> </td><td>" . htmlentities($_POST['desc-dmg']) . "</td></tr>";}
			if($_POST['spec-inst'] !='') {$message .= "<tr><td><strong>Special Instructions:</strong> </td><td>" . htmlentities($_POST['spec-inst']) . "</td></tr>";}
			$message .= "</table>";
			$message .= "</body></html>";
			
			
			
			
			//  MAKE SURE THE "FROM" EMAIL ADDRESS DOESN'T HAVE ANY NASTY STUFF IN IT
			
			$pattern = "/^[_a-z0-9-]+(\.[_a-z0-9-]+)*@[a-z0-9-]+(\.[a-z0-9-]+)*(\.[a-z]{2,3})$/i"; 
            if (preg_match($pattern, trim(strip_tags($_POST['req-email'])))) { 
                $cleanedFrom = trim(strip_tags($_POST['req-email'])); 
            } else { 
                return "The email address you entered was invalid. Please try again!"; 
            } 
			
			
            
            
            //   CHANGE THE BELOW VARIABLES TO YOUR NEEDS
             
			$to = 'office@damageana.com';
			
			$subject = 'New Assignment Request';
			
			$headers = "From: " . $cleanedFrom . "\r\n";
			$headers .= "Reply-To: ". strip_tags($_POST['req-email']) . "\r\n";
			$headers .= "MIME-Version: 1.0\r\n";
			$headers .= "Content-Type: text/html; charset=ISO-8859-1\r\n";

            if (mail($to, $subject, $message, $headers)) {
              echo 'Your message has been sent.';
            } else {
              echo 'There was a problem sending the email.';
            }
            
            // DON'T BOTHER CONTINUING TO THE HTML...
            die();
        
        }
    } else {
    
   		if (!isset($_SESSION[$form.'_token'])) {
   		
   		} else {
   			echo "Hack-Attempt detected. Got ya!.";
   			writeLog('Formtoken');
   	    }
   
   	}

?>

<!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="fr" lang="fr">

<head>

	<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />

	<title>New Assignment Request Form</title>

	<link rel="stylesheet" href="css/jqtransform.css" type="text/css" media="all" />
	<link rel="stylesheet" href="css/style.css" type="text/css" media="all" />
	
	<script src="http://www.google.com/jsapi" type="text/javascript"></script>
    <script type="text/javascript">
        google.load("jquery", "1.3.2");
    </script>
    
	<script type="text/javascript" src="js/jquery.jqtransform.js"></script>
	<script type="text/javascript" src="js/jquery.validate.js"></script>
	<script type="text/javascript" src="js/jquery.form.js"></script>
	<script type="text/javascript" src="js/websitechange.js"></script>
	
</head>

<?php
   // generate a new token for the $_SESSION superglobal and put them in a hidden field
	$newToken = generateFormToken('form1');   
?>

<body>
    <div id="page-wrap">
    
    <img src="http://www.damageana.com/images/logo.png"  alt="DANA_logo" width="750" height="70" />

    <h1>New Assignment Request Form</h1>

	<form action="new_assignment.php" method="post" id="change-form">
	
	<h4>IMPORTANT - PLEASE READ.</h4>
	<h3>
    -Please provide us with as much information as possible to aide us in setting up a new appraisal for you. 
    <br>
    <br>
    -Please be sure to provide as least one good contact number for the vehicle owner.
    <br>
    <br>
    -Once submitted, you will receive an acknowledgement in your e-mail with information regarding the appraisal for your claim.
    <br>
    <br>
    -If submitted before 3 PM, and no acknowledgement is received by 5 PM, please call our office to confirm we received the request.</h3> 
	
	    <input type="hidden" name="token" value="<?php echo $newToken; ?>">
	
		<div class="rowElem">
            <label for="req-company">Company*:</label>
            <input type="text" id="req-company" name="req-company" class="required" minlength="2" value="<?php echo $_COOKIE["NA-Company"]; ?>" />
        </div>
        
         <div class="rowElem">
            <label for="req-name">Adjuster*:</label>
            <input type="text" id="req-name" name="req-name" class="required" minlength="2" value="<?php echo $_COOKIE["NA-Name"]; ?>" />
        </div>
        
        <div class="rowElem">
            <label for="req-email">E-mail*:</label>
            <input type="text" name="req-email" class="required email" value="<?php echo $_COOKIE["NA-Email"]; ?>" />
        </div>
        
        <div class="rowElem">
        	<label for="req-phone">Phone*:</label>
        	<input type"text" id="req-phone" name="req-phone" class="required" maxlength="12" value="<?php echo $_COOKIE["NA-Phone"]; ?>" />
        </div>
        
        <div class="rowElem">
        	<label for="ext">Extension:</label>
        	<input type="text" id="ext" />
        </div>
        
        <div class="rowElem">
        	<label for="fax">Fax:</label>
        	<input type="text" id"fax" />
        </div>
      
        <h2>Claim Info</h2>
        
        <div class="rowElemSelect">
			<label for="assign_type">Assignment Type*:</label>
			<select name="assign_type" class="required">
				<option value="Automobile">Automobile</option>
				<option value="Recreational">Recreational</option>
				<option value="Heavy Equipment">Heavy Equipment</option>
				<option value="Property">Minor Property</option>
				<option value="Estimate Audit">Estimate Audit</option>
				<option value="Scene Investigation">Scene Investigation</option>
				<option value="Arbitration">Arbitration</option>
				<option value="DRP Inspection">DRP Quality Control Inspection</option>
				<option value="Photos Only">Photos Only</option>
			</select>
		</div>
		
		<br>
		
		<div class"rowElemSelect">
			<label for="loss_type">Type of Loss:</label>
			<select name="loss_type" id="loss_type">
				<option value="Collision">Collision</option>
				<option value="Comprehensive">Comprehensive</option>
				<option value="Other">Other</option>
			</select>
		</div>
		
		<div class="rowElem">
			<label for="req-claim">Claim #*:</label>
			<input type="text" id="req-claim" name="req-claim" class="required">
		</div>
        
        <div class="rowElem">
        	<label for"policy">Policy #:</label>
        	<input type="text" id="policy" name="policy">
        </div>
        
        <div class="rowElem">
        	<label for="ded">Deductible:</label>
        	<input type="text" id="ded" name="ded">
        </div>
        
        <div class="rowElem">
        	<label for="dol">Date of Loss:</label>
        	<input type="date" id="dol" name="dol">
        </div>

		<div class="rowElem">
		  <label for="Clmt-Own">Claimant Vehicle?</label>
		  <input type="checkbox" name="Clmt-Own" id="ClmtCheck" />
        </div>
        
        <h2>Insured Info</h2>
        
        <div class="rowElem">
        	<label for="insd">Insured:</label>
        	<input type="text" id="insd" name="insd">
        </div>
        
        <div class ="rowElem">
        	<label for="insd_add">Address:</label>
        	<input type="text" id="insd_add" name="insd_add">
        </div>
        
        <div class="rowElem">
        	<label for="insd_city">City:</label>
        	<input type="text" id="insd_city" name="insd_city">
        </div>
        
        <br>
        
        <div class="rowElem">
        	<label for="insd_st">State:</label>
        	<select name="insd_st" id="insd_st">
        		<option value="AL">AL</option>
				<option value="AK">AK</option>
				<option value="AZ">AZ</option>
				<option value="AR">AR</option>
				<option value="CA">CA</option>
				<option value="CO">CO</option>
				<option value="CT">CT</option>
				<option value="DE">DE</option>
				<option value="FL">FL</option>
				<option value="GA">GA</option>
				<option value="HI">HI</option>
				<option value="ID">ID</option>
				<option value="IL">IL</option>
				<option value="IN">IN</option>
				<option value="IA">IA</option>
				<option value="KS">KS</option>
				<option value="KY">KY</option>
				<option value="LA">LA</option>
				<option value="ME">ME</option>
				<option value="MD">MD</option>
				<option value="MA">MA</option>
				<option value="MI" selected="selected">MI</option>
				<option value="MN">MN</option>
				<option value="MS">MS</option>
				<option value="MO">MO</option>
				<option value="MT">MT</option>
				<option value="NE">NE</option>
				<option value="NV">NV</option>
				<option value="NH">NH</option>
				<option value="NJ">NJ</option>
				<option value="NM">NM</option>
				<option value="NY">NY</option>
				<option value="NC">NC</option>
				<option value="ND">ND</option>
				<option value="OH">OH</option>
				<option value="OK">OK</option>
				<option value="OR">OR</option>
				<option value="PA">PA</option>
				<option value="RI">RI</option>
				<option value="SC">SC</option>
				<option value="SD">SD</option>
				<option value="TN">TN</option>
				<option value="TX">TX</option>
				<option value="UT">UT</option>
				<option value="VT">VT</option>
				<option value="VA">VA</option>
				<option value="WA">WA</option>
				<option value="WV">WV</option>
				<option value="WI">WI</option>
				<option value="WY">WY</option>
        	</select>
        </div>
        
        <div class="rowElem">
        	<label for="insd-zip">Zip Code:</label>
        	<input type="text" name="insd-zip" id="insd-zip" minlength="5" maxlength="10">
        </div>
        
        <div class="rowElem">
        	<label for="insd-home">Home Phone:</label>
        	<input type="text" name="insd-home" id="insd-home" maxlength="12">
        </div>
        
        <div class="rowElem">
        	<label for="insd-work">Work Phone:</label>
        	<input type="text" name="insd-work" id="insd-work" maxlength="12">
        </div>
        
        <div class="rowElem">
        	<label for="insd-cell">Mobile Phone:</label>
        	<input type="text" name="insd-cell" id="insd-cell" maxlength="12">
        </div>
        
        <div class="rowElem">
        	<label for="insd-other">Other Phone:</label>
        	<input type="text" name="insd-other" id="insd-other" maxlength="12">
        </div>
        
        <br>
        
        <div id="Clmt-Info">
        	
        	<h2>Claimant Info</h2>
        	
        	<div class="rowElem">
	        	<label for="clmt">Claimant:</label>
	        	<input type="text" id="clmt" name="clmt">
	        </div>
	        
	        <div class ="rowElem">
	        	<label for="clmt_add">Address:</label>
	        	<input type="text" id="clmt_add" name="clmt_add">
	        </div>
	        
	        <div class="rowElem">
	        	<label for="clmt_city">City:</label>
	        	<input type="text" id="clmt_city" name="clmt_city">
	        </div>
	        
	        <br>
	        
	        <div class="rowElem">
	        	<label for="clmt_st">State:</label>
	        	<select name="clmt_st" id="clmt_st">
	        		<option value="AL">AL</option>
					<option value="AK">AK</option>
					<option value="AZ">AZ</option>
					<option value="AR">AR</option>
					<option value="CA">CA</option>
					<option value="CO">CO</option>
					<option value="CT">CT</option>
					<option value="DE">DE</option>
					<option value="FL">FL</option>
					<option value="GA">GA</option>
					<option value="HI">HI</option>
					<option value="ID">ID</option>
					<option value="IL">IL</option>
					<option value="IN">IN</option>
					<option value="IA">IA</option>
					<option value="KS">KS</option>
					<option value="KY">KY</option>
					<option value="LA">LA</option>
					<option value="ME">ME</option>
					<option value="MD">MD</option>
					<option value="MA">MA</option>
					<option value="MI" selected="selected">MI</option>
					<option value="MN">MN</option>
					<option value="MS">MS</option>
					<option value="MO">MO</option>
					<option value="MT">MT</option>
					<option value="NE">NE</option>
					<option value="NV">NV</option>
					<option value="NH">NH</option>
					<option value="NJ">NJ</option>
					<option value="NM">NM</option>
					<option value="NY">NY</option>
					<option value="NC">NC</option>
					<option value="ND">ND</option>
					<option value="OH">OH</option>
					<option value="OK">OK</option>
					<option value="OR">OR</option>
					<option value="PA">PA</option>
					<option value="RI">RI</option>
					<option value="SC">SC</option>
					<option value="SD">SD</option>
					<option value="TN">TN</option>
					<option value="TX">TX</option>
					<option value="UT">UT</option>
					<option value="VT">VT</option>
					<option value="VA">VA</option>
					<option value="WA">WA</option>
					<option value="WV">WV</option>
					<option value="WI">WI</option>
					<option value="WY">WY</option>
	        	</select>
	        </div>
	        
	        <div class="rowElem">
	        	<label for="clmt-zip">Zip Code:</label>
	        	<input type="text" name="clmt-zip" id="clmt-zip" minlength="5" maxlength="10">
	        </div>
	        
	           	<div class="rowElem">
				   	<label for="clmt-home">Home Phone:</label>
				   	<input type="text" name="clmt-home" id="clmt-home" maxlength="12">
				</div>
        
				<div class="rowElem">
					<label for="clmt-work">Work Phone:</label>
					<input type="text" name="clmt-work" id="clmt-work" maxlength="12">
				</div>
        
		        <div class="rowElem">
		        	<label for="clmt-cell">Mobile Phone:</label>
		        	<input type="text" name="clmt-cell" id="clmt-cell" maxlength="12">
		        </div>
		        
		        <div class="rowElem">
		        	<label for="clmt-other">Other Phone:</label>
		        	<input type="text" name="clmt-other" id="clmt-other" maxlength="12">
		        </div>
        </div>
        
        <br>
              
        <h2>Damaged Unit Information</h2>
        
        <div class="rowElem">
        	<label for="VIN">VIN:</label>
        	<input type="text" name="VIN" id="VIN" maxlength="17">
        </div>
        
        <div class="rowElem">
		  	<label for="veh-year">Year:</label>
		  	<input type="text" name="veh-year" id="veh-year" maxlength="4">
        </div>
        
        <div class="rowElem">
        	<label for="veh-make">Make:</label>
        	<input type="text" name="veh-make" id="veh-make">
        </div>
        
        <div class="rowElem">
        	<label for="veh-model">Model:</label>
        	<input type="text" name="veh-model" id="veh-model">
        </div>
        
        <div class="rowElem">
        	<label for="lic_pl">License Plate:</label>
        	<input type="text" name="lic_pl" id"lic_pl">
        </div>
        
        <div class="rowElem">
        	<label for="veh-color">Color:</label>
        	<input type="text" name="veh-color" id="veh-color">
        </div>
        
        <div class="rowElem">
		    <label>Unit Location:</label> 
		    
		    <div id="changeLocation">
		
    			<input type="radio" name="location" id="owner" value="With the Owner" checked="checked" />
    			<label for="owner">With the Owner</label>
    			
    			<div class="clear"></div>
				
				<label></label>
    			<input type="radio" name="location" id="alt-loc" name="loc" value="At Another Location" />
    			<label for="alt-loc">At Another Location (i.e. Body Shop, Tow Yard, Workplace)</label>
			
			</div>
        </div>
        
        <br>
        <div class="clear"></div>
        <br>
        <br>
        
        
        <div id="loc-info">
        	<div class="rowElem">
        		<label for="loc-name">Location Name:</label>
        		<input type="text" name="loc-name" id="loc-name">
        	</div>
        	
        	<div class="rowElem">
        		<label for="loc-add">Location Address:</label>
        		<input type="text" name="loc-add" id="loc-add">
        	</div>
        	
        	<div class="rowElem">
        		<label for="loc-city">Location City:</label>
        		<input type="text" name="loc-city" id="loc-city">
        	</div>
        	
        	<div class="rowElem">
	        	<label for="loc-st">State:</label>
	        	<select name="loc-st" id="loc-st">
	        		<option value="AL">AL</option>
					<option value="AK">AK</option>
					<option value="AZ">AZ</option>
					<option value="AR">AR</option>
					<option value="CA">CA</option>
					<option value="CO">CO</option>
					<option value="CT">CT</option>
					<option value="DE">DE</option>
					<option value="FL">FL</option>
					<option value="GA">GA</option>
					<option value="HI">HI</option>
					<option value="ID">ID</option>
					<option value="IL">IL</option>
					<option value="IN">IN</option>
					<option value="IA">IA</option>
					<option value="KS">KS</option>
					<option value="KY">KY</option>
					<option value="LA">LA</option>
					<option value="ME">ME</option>
					<option value="MD">MD</option>
					<option value="MA">MA</option>
					<option value="MI" selected="selected">MI</option>
					<option value="MN">MN</option>
					<option value="MS">MS</option>
					<option value="MO">MO</option>
					<option value="MT">MT</option>
					<option value="NE">NE</option>
					<option value="NV">NV</option>
					<option value="NH">NH</option>
					<option value="NJ">NJ</option>
					<option value="NM">NM</option>
					<option value="NY">NY</option>
					<option value="NC">NC</option>
					<option value="ND">ND</option>
					<option value="OH">OH</option>
					<option value="OK">OK</option>
					<option value="OR">OR</option>
					<option value="PA">PA</option>
					<option value="RI">RI</option>
					<option value="SC">SC</option>
					<option value="SD">SD</option>
					<option value="TN">TN</option>
					<option value="TX">TX</option>
					<option value="UT">UT</option>
					<option value="VT">VT</option>
					<option value="VA">VA</option>
					<option value="WA">WA</option>
					<option value="WV">WV</option>
					<option value="WI">WI</option>
					<option value="WY">WY</option>
	        	</select>
	        </div>
        	
        	<div class="rowElem">
        		<label for="loc-zip">Location Zip:</label>
        		<input type="text" name="loc-zip" id="loc-zip" minlength="5" maxlength="10">
        	</div>
        	
        	<div class="rowElem">
        		<label for="loc-con">Location Contact:</label>
        		<input type="text" name="loc-con" id="loc-con">
        	</div>
        	
        	<div class="rowElem">
        		<label for="loc-phone">Location Phone:</label>
        		<input type="text" name="loc-phone" id="loc-phone" maxlength="12">
        	</div>
        	
        </div>
        
        <br>
       
		<div class="rowElem">
		  <label for="desc-loss">Description of Loss:</label>
		  <textarea cols="40" rows="8" name="desc-loss"></textarea>
        </div>
       
		<div class="rowElem">
		  <label for="desc-dmg">Description of Damage:</label>
		  <textarea cols="40" rows="8" name="desc-dmg"></textarea>
        </div>
        
        <div class="rowElem">
		  <label for="spec-inst">Special Instructions:</label>
		  <textarea cols="40" rows="8" name="spec-inst"></textarea>
        </div>
        
		<div class="rowElem">
		  <label> &nbsp; </label>
		  <input type="submit" value="Submit Request" />
        </div>
        
		<div class="rowElem">
		  <label> &nbsp; </label>
		  <input type="reset" value="Reset" />
		</div>
        
        <div id="rowElem">
          <label>Click to Save:</label>
		  <input type="checkbox" name="save-company" />
		  <label for="save-company">Company Name</label>
        </div>
        
        <div class="clear"></div>
        
        <div id="rowElem">
        	<label> &nbsp; </label>
        	<input type="checkbox" name="save-name" />
        	<label for="save-name">Adjuster's Name</label>
        </div>
        
        <div class="clear"></div>
        
        <div id="rowElem">
        	<label> &nbsp; </label>
        	<input type="checkbox" name="save-email" />
        	<label for="save-email">Adjuster's E-mail</label>
        </div>
        
        <div class="clear"></div>
        
        <div id="rowElem">
        	<label> &nbsp; </label>
        	<input type="checkbox" name="save-phone" />
        	<label for="save-phone">Adjuster's Phone</label>
        </div>
        			
	</form>
	
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