PHP - How Can I Enter Form Data Into Database?

How can I build a form with a drop down menu with the year, day, month?  And then send that information to a database.

If there is another/better option besides a drop down menu?  If so, please tell me.

The rest of the form is working fine, and all the inforamtion is going to the database - last name, first name, address, phone number, zip code, race,,,,,,,,,.

 I work for a not-for-profit medical office - we provide medical services to the local people who can not afford to go to a regular doctor.  We need a simple way to keep track of patient information.  One of the things we need to enter is the birthdate. 

Searching the forums provided a lot of results, but the words date and form are used so much, I can not find anything that helped me.  I also looked through php.net, but can not find anything there.

I have a form on our website that a user can fill out for custom product.  I want the form data to be 1) stored into a mysql database AND after storing said data, 2) email the same data to our sales department.

1)  The form data DOES get stored into mysql database (except for the first two fields, for some weird reason)

2) I added a "mail" section to the php file that stores the data into the database, but it is not working correctly.  I have stripped the email portion down to sending just one of the fields in the "message" to make it easier for troubleshooting

I have included here, both the form section of the html file, and the formdata.php file that processes the data for your  analysis.  I am relatively new to php so there are going to be some issues with security, but I can work on those after I get the store & email process to work correctly.  Please review my code and see if anyone can be of assistance.  I looked through the forums and couldn't find another issue that was the same as mine.  If I just overlooked, please tell me the thread post #.  Thanks

THE FORM WHICH COLLECTS THE DATA
*******************************
<form method=POST action=formdata.php>

                 
  <table width="640" border=0 align="center">
    <tr>
      <td align=right><b>First Name</b></td>
      <td><input type=text name=FName size=25></td>
      <td><div align="right"><b>Telephone</b></div></td>
      <td><input type=text name=Tel size=25></td>
    </tr>
    <tr>
      <td align=right><b>Last Name</b></td>
      <td><input type=text name=LName size=25></td>
      <td><div align="right"><b>Fax</b></div></td>
      <td><input type=text name=Fax size=25></td>
    </tr>
    <tr>
      <td align=right><b>Title</b></td>
      <td><input type=text name=Title size=25></td>
      <td><div align="right"><b>Email</b></div></td>
      <td><input type=text name=Email size=50></td>
    </tr>
    <tr>
      <td align=right><b>Company</b></td>
      <td><input type=text name=Comp size=25></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b>Address</b></td>
      <td><input type=text name=Addr size=25></td>
      <td><div align="right"><b>Estimated Annual Volume</b></div></td>
      <td><input type=text name=EAV size=25></td>
    </tr>
    <tr>
      <td align=right><b>City</b></td>
      <td><input type=text name=City size=25></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b>State/Province</b></td>
      <td><input type=text name=SProv size=25></td>
      <td><div align="right"><b>Application</b></div></td>
      <td><input type=text name=Appl size=25></td>
    </tr>
    <tr>
      <td align=right><b>Country</b></td>
      <td><input type=text name=Ctry size=25></td>
      <td><div align="right"><b>Type of System</b></div></td>
      <td><input type=text name=Syst size=25></td>
    </tr>
    <tr>
      <td align=right><b>Zip/Postal Code</b></td>
      <td><input type=text name=ZPC size=25></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td><div align="right"><strong><font color="#FFFF00" face="Arial, Helvetica, sans-serif">COIL
          DESIGN</font></strong></div></td>
      <td><font color="#FFFF00" face="Arial, Helvetica, sans-serif"><strong>PARAMETERS</strong></font></td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b>Primary Resistance (ohms)</b></td>
      <td><input type=text name=Pres size=25></td>
      <td><div align="right"><b>Primary Inductance (mH)</b></div></td>
      <td><input type=text name=Pind size=25></td>
    </tr>
    <tr>
      <td align=right><b>Secondary Resistance (ohms)</b></td>
      <td><input type=text name=Sres size=25></td>
      <td><div align="right"><b>Secondary Inductance (H)</b></div></td>
      <td><input type=text name=Sind size=25></td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b>Peak Operating Current (Amps)</b></td>
      <td><input type=text name=POC size=25></td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b>Output Energy (mJ)</b></td>
      <td><input type=text name=Egy size=25></td>
      <td><div align="right"><b>Output Voltage (kV)</b></div></td>
      <td><input type=text name=Volt size=25></td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right><b># HV Towers per Coil</b></td>
      <td><input type=text name=TPC size=25></td>
      <td><div align="right"><b># of Coils per Package</b></div></td>
      <td><input type=text name=CPP size=25></td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <td align=right>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
    <tr>
      <th colspan=4><b>Please enter any additional information he </b></th>
    </tr>
    <tr>
      <th colspan=4><textarea name=Mess cols=50 rows=10 id="Message"></textarea></th>
    </tr>
  </table>
  </dl>
  <div align="center">
    <p>
      <input type=hidden name=BodyTag value="&lt;body  bgcolor=&quot;#484589&quot; text=&quot;#FFFFFF&quot; link=&quot;#FFFF00&quot; alink=&quot;#FFFFFF&quot; vlink=&quot;#FF7F00&quot;&gt;">
      <input type=hidden name=FA value=SendMail>
    </p>
    <p><font color="#FFFF00" face="Arial, Helvetica, sans-serif"><strong>PLEASE MAKE SURE ALL
      INFORMATION<br>
      IS CORRECT BEFORE SUBMITTING</strong></font></p>
    <p>
      <input type=submit value="Submit Form">
    </p>
  </div>
</form>
THE FILE THAT PROCESSES THE FORM DATA (formdata.php)
***********************************************
<?php
$con = mysql_connect("localhost","XXX","XXX");
if (!$con)
  {
  die('Could not connect: ' . mysql_error());
  }

mysql_select_db("customform", $con);

$sql="INSERT INTO formdata (Fname, Lname, Title, Comp, Addr, City, SProv, Ctry, ZPC, Tel, Fax, Email, EAV, Appl, Syst, Pres, Pind, Sres, Sind, POC, Egy, Volt, TPC, CPP, Mess)
VALUES ('$_POST[Fname]','$_POST[Lname]','$_POST[Title]','$_POST[Comp]','$_POST[Addr]','$_POST[City]','$_POST[SProv]','$_POST[Ctry]','$_POST[ZPC]','$_POST[Tel]','$_POST[Fax]','$_POST[Email]','$_POST[EAV]','$_POST[Appl]','$_POST[Syst]','$_POST[Pres]','$_POST[Pind]','$_POST[Sres]','$_POST[Sind]','$_POST[POC]','$_POST[Egy]','$_POST[Volt]','$_POST[TPC]','$_POST[CPP]','$_POST[Mess]')";

if (!mysql_query($sql,$con))
  {
  die('Error: ' . mysql_error());
  }
echo "Your Information Was Successfully Posted";

mysql_close($con);

$to = "recipient email address here"; 
$subject = "Custom Form"; 
$email = $_POST['Email'] ; 
$message = $_POST['Comp'] ; 
$headers = "From: $Email"; 
$sent = mail($to, $subject, $message, $headers) ; 
if($sent) 
{print "Your mail was sent successfully"; }
else 
{print "We encountered an error sending your mail"; }
?>

Hi All

I have a contact form whcih works great - its has a little validation on it and sends me all the information I need via email.
I now want to store all data submitted via the form to be stored in a MySQL database.

What is the best way to do this??

Attached is my form as it is, just being emailed to the relevent accounts.

Look forward to your replies.

Adi

helo

does anyone know how to display data from db in checkbox form? i have been searching for days and still cannot find answer that i can understand. i hope someone can help me. i really am lost. any help is much appreciated

I almost have it but I am missing something. The form is being sent and the row is being created but there is not data. It is blank. I know it is something simple I am missing but I cannot figure it out   If anyone can look at my code below and tell me what I am missing to make the inputed info be seen, I would sure appreciate it.

<?php

include_once('class/class_email.php');

// contact to database
$connect = mysql_connect("localhost", "admin", "password") or die ("Error , check your server connection.");

mysql_select_db("database");

$fname = $_POST['fname'];
$lname = $_POST['lname'];
$email = $_POST['email'];
$company = $_POST['company'];
$telephone = $_POST['telephone'];
$comments = $_POST['comments'];
$EID = $_POST['eid'];
extract ($_POST);

// Pick up the form data and assign it to variables
// 
$id = intval($id);
$fname = strip_tags($fname);
$lname = strip_tags($lname);
$email = strip_tags($email);
$company = strip_tags($company);
$telephone = intval($telephone); 


$query="INSERT INTO users(`id`, `fname`, `lname`, `email`,`company`,`telephone`) VALUES('$id','$fname','$lname','$email','$company','$telephone')";

echo $query;

mysql_query($query)  or die(mysql_error());
echo mysql_error();

$SQL_GetEquipment = "SELECT * FROM `new_equip` WHERE `id`='$EID' LIMIT 1;";
$result = mysqli_query($connect,$SQL_GetEquipment);
$row = mysqli_fetch_assoc($result);
$EmailBody = "$fname $lname has requested a quote from NAPE on Item $EID\n 

Information on quote request: \n
Name: $fname $lname \n
Email: $email \n
Company: $company \n
Number: $telephone  \n 
Comments: $comments  \n 
\n
Information Requested for: {$row['itemname']}\n
The URL to {$row['itemname']} is: http://www.mydomain.com.com/new-product.php?Item=$EID
\n
Click to send a quote now:\n
http://www.mydomain.com.com/Admin/send-quote.php?id=$EID ";

$e = new email();

//First value is the URL of your server, the second the port number
$e->set_server( 'mail.mydomain.com.com', 26);

//First value is your username, then your password
$e->set_auth('noreply@mydomain.com', '112233');

//Set the "From" setting for your e-mail. The Name will be base64 encoded
$e->set_sender( 'Quote Requested', 'noreply@mydomain.com' );

//for one recipient
//$send_to = array('myemail@mydomain.com','myemail2@mydomain.com');
$send_to = ('myemail@gmail.com');
//you may also specify multiple recipients by creating an array like this:
//$send_to = array('foo1@localhost.local', 'foo2@localhost.local', 'foo3@localhost.local');


$subject = 'Quote Request from NAPE';
$body = "$EmailBody";
if( $e->mail($send_to, $subject, $body, $headers) == true )
{
  //message was received by the smtp server
  //['last'] tends to contain the queue id so I like to save that string in the database
  echo 'last: '.htmlspecialchars($e->srv_ret['last']).'';
}else{
  //something went wrong
  echo 'all: '.nl2br(htmlspecialchars($e->srv_ret['all'])).'';
  echo 'full:'.nl2br(htmlspecialchars($e->srv_ret['full'])).'';
}

?>