PHP - Encrypting A Form

I'm using PHP and MySQL. I have an application where I'd like to keep certain database (character) fields encrypted when added to the database and stored, but when I need to display them at the appropriate time, I can call a function and quickly decrypt them for display.

Does anyone know of a simple way to do this?

Thanks!

Hello, I have coded a contact form in PHP and I want to know, if according to you, it is secure! I am new in PHP, so I want some feedback from you.

Moreover, I have also two problems based on the contact form. It is a bit complicated to explain, thus, I will break each of my problem one by one.

FIRST:The first thing I want to know, is if my contact form secure according to you:

The HTML with the PHP codes:

Code: [Select]
<?php
if ($_SERVER['REQUEST_METHOD'] == 'POST') {

//Assigning variables to elements
$first = htmlentities($_POST['first']);
$last = htmlentities($_POST['last']);
$sub = htmlentities($_POST['subject']);
$email = htmlentities($_POST['email']);
$web = htmlentities($_POST['website']);
$heard = htmlentities($_POST['heard']);
$comment = htmlentities($_POST['message']);
$cap = htmlentities($_POST['captcha']);

//Declaring the email address with body content
$to = 'alithebestofall2010@gmail.com';
$body ="First name: '$first' \n\n Last name: '$last' \n\n Subject: '$sub' \n\n Email: '$email' \n\n Website: '$web' \n\n Heard from us: '$heard' \n\n Comments: '$comment'";

//Validate the forms
if (empty($first) || empty($last) || empty($sub) || empty($email) || empty($comment) || empty($cap)) {
echo '<p class="error">Required fields must be filled!</p>';
header ('refresh= 3; url= index.php');
return false;

} 
elseif (filter_var($first, FILTER_VALIDATE_INT) || filter_var($last, FILTER_VALIDATE_INT)) {
echo '<p class="error">You cannot enter a number as either the first or last name!</p>';
return false;
} 
elseif (!filter_var($email, FILTER_VALIDATE_EMAIL)) {
echo '<p class="error">Incorrect email address!</p>';
return false;
}
elseif (!($cap === '12')){
echo '<p class="error">Invalid captcha, try again!</p>';
return false;
}
else {
mail ($to, $sub, $body);
echo '<p class="success">Thank you for contacting us!</p>';
}
}
?>
<form action="<?php echo $_SERVER['PHP_SELF'];?>" method="post">
<p>Your first name: <span class="required">*</span></p>
<p><input type="text" name="first" size="40" placeholder="Ex: Paul"/></p>

<p>Your last name: <span class="required">*</span></p>
<p><input type="text" name="last" size="40" placeholder="Ex: Smith"/></p>

<p>Subject: <span class="required">*</span></p>
<p><input type="text" name="subject" size="40" placeholder="Ex: Contact"/></p>

<p>Your email address: <span class="required">*</span></p>
<p><input type="text" name="email" size="40" placeholder="Ex: example@xxx.com"/></p>

<p>Website:</p>
<p><input type="text" name="website" size="40" placeholder="Ex: http//:google.com"/></p>

<p>Where you have heard us?: <span class="required">*</span></p>
<p><select name="heard">
<option>Internet</option>
<option>Newspapers</option>
<option>Friends or relatives</option>
<option>Others</option>
</select></p>

<p>Your message: <span class="required">*</span></p>
<p><textarea cols="75" rows="20" name="message"></textarea></p>

<p>Are you human? Sum this please: 5 + 7 = ?: <span class="required">*</span></p></p>
<p><input type="text" name="captcha" size="10"/></p>

<p><input type="submit" name="submit" value="Send" class="button"/>
<input type="reset" value="Reset" class="button"/></p>
</form>

SECOND PROBLEM:If a user has made a mistake, he gets the error message so that he can correct! However, when a mistake in the form occurs, all the data the user has entered are disappeared! I want the data to keep appearing so that the user does not start over again to fill the form.

THIRD: When the erro message is displayed to notify the user that he made a mistake when submitting the form, the message is displaying on the top of the page. I want it to appear below each respective field. How to do that? In JQuery it is simple, but in PHP, I am confusing!

Stumped!  I have a client who has a form where they upload files to their server: title, two password fields, and the file They have been unable to upload anything over 10m   Small (under 10mb) files work. Larger doesn’t I’ve tracked it down, I think, that the processing page appears to be dropping the form values when the file takes a bit to upload.   I echo’ed the values that are grabbed from the form, and they return empty strings if it takes a while for the file to upload (a large file) - they pass fine if the file is smaller.   I think I've got the php info set correctly, but cannot for the life of me figure out how to adjust the timing out issue, or even where to troubleshoot.   Here's my phpinfo:   Max Requests Per Child: 750 - Keep Alive: off - Max Per Connection: 100 Timeouts Connection: 120 - Keep-Alive: 5     Directive Local Value Master Value allow_call_time_pass_reference Off Off allow_url_fopen On On allow_url_include Off Off always_populate_raw_post_data Off Off arg_separator.input & & arg_separator.output & & asp_tags Off Off auto_append_file no value no value auto_globals_jit On On auto_prepend_file no value no value browscap /etc/browscap.ini /etc/browscap.ini default_charset no value no value default_mimetype text/html text/html define_syslog_variables Off Off disable_classes no value no value disable_functions leak,posix_getpwuid,posix_getpwnam,posix_getgrid,posix_getgrnam,posix_getgroups leak,posix_getpwuid,posix_getpwnam,posix_getgrid,posix_getgrnam,posix_getgroups display_errors Off Off display_startup_errors Off Off doc_root no value no value docref_ext no value no value docref_root no value no value enable_dl Off Off error_append_string no value no value error_log /mnt/Target01/337846/945285/www.dermerrealestate.com/logs/php_errors.log no value error_prepend_string no value no value error_reporting 30711 30711 exit_on_timeout Off Off expose_php Off Off extension_dir /usr/lib64/php/modules /usr/lib64/php/modules file_uploads On On highlight.bg #FFFFFF #FFFFFF highlight.comment #FF8000 #FF8000 highlight.default #0000BB #0000BB highlight.html #000000 #000000 highlight.keyword #007700 #007700 highlight.string #DD0000 #DD0000 html_errors On On ignore_repeated_errors Off Off ignore_repeated_source Off Off ignore_user_abort Off Off implicit_flush Off Off include_path .:/usr/share/pear:/usr/share/php .:/usr/share/pear:/usr/share/php log_errors On On log_errors_max_len 1024 1024 magic_quotes_gpc On On magic_quotes_runtime Off Off magic_quotes_sybase Off Off mail.add_x_header On On mail.force_extra_parameters no value no value mail.log no value no value max_execution_time 30 30 max_file_uploads 20 20 max_input_nesting_level 64 64 max_input_time 60 60 max_input_vars 1000 1000 memory_limit 128M 128M open_basedir no value no value output_buffering no value no value output_handler no value no value post_max_size 8M 8M precision 14 14 realpath_cache_size 4M 4M realpath_cache_ttl 120 120 register_argc_argv On On register_globals Off Off register_long_arrays On On report_memleaks On On report_zend_debug On On request_order no value no value safe_mode Off Off safe_mode_exec_dir no value no value safe_mode_gid Off Off safe_mode_include_dir no value no value sendmail_from no value no value sendmail_path /usr/sbin/sendmail -t -i /usr/sbin/sendmail -t -i serialize_precision 100 100 short_open_tag On On SMTP localhost localhost smtp_port 25 25 sql.safe_mode Off Off track_errors Off Off unserialize_callback_func no value no value upload_max_filesize 8M 8M upload_tmp_dir /tmp /tmp user_dir no value no value user_ini.cache_ttl 300 300 user_ini.filename .user.ini .user.ini variables_order EGPCS EGPCS xmlrpc_error_number 0 0 xmlrpc_errors Off Off y2k_compliance On On zend.enable_gc On On  

I have read around and can't seem to find the right coding for what I need on this forum and some other other forums.

I have a contact form (as listed below) and I need 2 locations (Print Name and Title) fields to auto-populate on a separate form (can be a doc, pdf, etc. any form of document which is easiest) and this form can be totally back end and the individual using the form never is going to see the form.

It's going on a contract form, that we would like to auto-populate.

Also is there a simple attachment code so individuals can attach documents to the code?


<p style: align="center"><form action="mailtest.php" method="POST">
<?php
$ipi = getenv("REMOTE_ADDR");
$httprefi = getenv ("HTTP_REFERER");
$httpagenti = getenv ("HTTP_USER_AGENT");
?>

<input type="hidden" name="ip" value="<?php echo $ipi ?>" />
<input type="hidden" name="httpref" value="<?php echo $httprefi ?>" />
<input type="hidden" name="httpagent" value="<?php echo $httpagenti ?>" /> 
<div align="center">
<p class="style1">Name</p> 
<input type="text" name="name">
<p class="style1">Address</p> 
<input type="text" name="address">
<p class="style1">Email</p> 
<input type="text" name="email">
<p class="style1">Phone</p> 
<input type="text" name="phone">
<p class="style1">Debtor</p> 
<input type="text" name="debtor">
<p class="style1">Debtor Address</p> 
<input type="text" name="debtora">
<br />
<br />
<a href="authoforms.php" target="_blank" style="color:#ffcb00"  vlink="#ffcb00">Click here to view Assignment Agreement and Contract Agreement</a>

<p class="style1"><input type='checkbox' name='chk' value='I Have read and Agree to the terms.'> I have read and agree to the Assignment and Contract Agreement <br></p>
<p class="style1">Print Name</p> 
<input type="text" name="pname">
<p class="style1">Title</p> 
<input type="text" name="title">


<p class="style1">I hear by agree that the information I have provided is true, accurate and the information I am submitting is <br />
not fraudulent. Please click the agree button that you adhere to Commercial Recovery Authority Inc.'s terms:</p>
<select name="agree" size="1">
<option value="Agree">Agree</option>
<option value="Disagree">Disagree</option>
</select>
<br />
<br />
<p class="style1">Employee ID:</p> 
<input type="text" name="employee">

<br />

<input type="submit" value="Send"><input type="reset" value="Clear">
</div>
</form>
</p>


The mailtest php is this
?php
$ip = $_POST['ip'];
$httpref = $_POST['httpref'];
$httpagent = $_POST['httpagent'];
$name = $_POST['name'];
$address = $_POST['address'];
$email = $_POST['email'];
$phone = $_POST['phone'];
$debtor = $_POST['debtor'];
$debtora = $_POST['debtora'];
$value = $_POST['chk'];
$pname = $_POST['pname'];
$title = $_POST['title'];
$agree = $_POST['agree'];
$employee = $_POST['employee'];
$formcontent=" From: $name \n Address: $address \n Email: $email \n Phone: $phone \n Debtor: $debtor \n Debtor's Address: $debtora \n 'Client' has read Assignment and Contract Agreement: $value \n Print Name: $pname \n Title: $title \n I hear by agree that the information I have provided is true, accurate and the information I am submitting is not fraudulent. Please click the agree button that you adhere to Commercial Recovery Authority Inc.'s terms: $agree \n \n  Employee ID: $employee \n IP: $ip";
$recipient = "mail@crapower.com";
$subject = "Online Authorization Form 33.3%";
$mailheader = "From: $email \r\n";
mail($recipient, $subject, $formcontent, $mailheader) or die("Error!");
echo "Thank You!" . " -" . "<a href='index.php' style='text-decoration:none;color:#ffcb00;'> Return Home</a>";
$ip = $_POST['visitoraddress']
?>

Hello, first time poster..  I've looked the web over for a long time and can't figure this one out.

- Below is basic code that successfully checks MySQL for a match and displays result.  I was debugging and forced the "height" and "width" to be 24 and 36 to make sure that wasn't the problem.  That's good.. 
- I'd like to give the user ability to select width and height from a form.. and have it do an onchange this.form.submit so the form can be changing as fields are altered (thus the onchange interaction)
- In a normal coding environment I've done this numerous times with no "Page cannot be displayed" problems.  It would simply change one select-option value at a time til they get down the form and click submit...  but in WordPress I'm having trouble making even ONE single onchange work!
- I've implemented the plugins they offer which allows you to "copy+paste" your php code directly into their wysiwyg editor.  That works with basic tests like my first bullet point above.
- I've copied and pasted the wordpress url (including the little ?page_id=123) into the form "action" url... that didn't work...  tried forcing it into an <option value=""> tag.. didn't work.  I'm just not sure. 

I've obviously put xx's in place of private info..

Why does this form give me Page Cannot Be Displayed in WordPress every time?  It won't do anything no matter how simple.. using onchange..

Code..

$con = mysql_connect("xxxx.xxxxxxx.com","xxxxxx","xxxxx");
if (!$con)
  {
  die('Could not connect: ' . mysql_error());
  }
mysql_select_db("xxxxxx", $con);
$myprodwidth=24;
$myprodheight=36;
$result = mysql_query("SELECT * FROM product_sizes WHERE prodwidth='$myprodwidth' and prodheight='$myprodheight'");
while($row = mysql_fetch_array($result))
  {
  echo $row['prodprice'];
  }
mysql_close($con);


<form method="post" action="">
<select name="myheight" onchange="this.form.submit();">
<option selected="selected" value="">select height</option>
<option value="xxxxxxxxx.com/wordpress/?page_id=199&height=36">36</option>
<option value="xxxxxxxxx.com/wordpress/?page_id=199&height=36">48</option>
</select>

There are two pieces to this- The HTML Form and the resulting php. I can't seem to make the leap, from the code to having the form produce the php page so others can view it until the form is again submitted overwriting the php, thus generating new content.

The environment I am working in is limited to IIs 5.1 and php 5.2.17 without mySQL or other DB

I'm new to php, this isn't homework,or commercialization,  it's for children.  I am thinking perhaps fwrite / fread but can't get my head around it.

Code snipets below. Any help, please use portions of this code in hopes I can understand it

Thanks

Code snipet from Output.php
Code: [Select]
<?php
$t1image = $_POST["t1image"];
$t1title = $_POST["t1title"];
$t1info = $_POST["t1info"];
$t2image = $_POST["t2image"];
$t2title = $_POST["t2title"];
$t2info = $_POST["t2info"];
?>
...
<tbody>
    <tr><!--Headers-->
      <td style="vertical-align: top; text-align: center; background-color: rgb(204, 255, 255);">Animal</td>
      <td style="vertical-align: top; text-align: center; background-color: rgb(204, 255, 255);">Image thumb<br>
      </td>
      <td style="vertical-align: top; text-align: center; background-color: rgb(204, 255, 255);">Date<br>
      </td>
      <td style="vertical-align: top; text-align: center; background-color: rgb(204, 255, 255);">Information<br>
      </td>
    </tr>
    <tr>
      <td style="vertical-align: top; text-align: center;">Monkey
      </td>
      <td style="vertical-align: top; text-align: center;"><img src="<?php echo $t1image.'.gif'; ?>"><!--single image presented selected from radio buttons-->
      </td>
      <td style="vertical-align: top; text-align: center;"><?php echo date("m/d/Yh:i A"); ?><!--time stamp generated when submitted form populates all fields at once-->
      </td>
      <td style="vertical-align: top; text-align: center;"><a href="#monkey" rel="facebox"><?php echo $t1title ?></a><!--Link name provided by "Title 1", that links to hidden Div generated page with content from "Info1" field-->
  <div id="Monkey" style="display:none">
<?php echo $t1info; ?>
</div>
      </td>
    </tr>
    <tr>
      <td style="vertical-align: top; text-align: center;">Cat<br>
      </td>
      <td style="vertical-align: top; text-align: center;"><img src="<?php echo $t2image.'.gif'?>"></td>
      <td style="vertical-align: top; text-align: center;"><?php echo date("m/d/Yh:i A"); ?></td>
      <td style="vertical-align: top; text-align: center;"><a href="#Cat" rel="facebox"><?php echo $t2title ?></a>
  <div id="Cat" style="display:none">
<?php echo $t2info; ?>
</div>
      </td>
    </tr>
    <tr>

This replicates several times down the page around 15-20 times ( t1### - t20###)


Code Snipet from HTML Form
Code: [Select]
<form action="animals.php" method="post">
<div style="text-align: left;"><big
style="font-family: Garamond; font-weight: bold; color: rgb(51, 51, 255);"><big><big><span>Monkey</span></big></big></big><br>
<table style="text-align: left; width: 110px;" border="0"
cellpadding="2" cellspacing="0">
<tbody><tr>
<td style="vertical-align: top;">Image thumb<br>
<input type="radio" name="t1image" value="No opinion" checked><img src="eh.gif" alt="Eh">
<input type="radio" name="t1image" value="Ok"><img src="ok.gif" alt="ok">
<input type="radio" name="t1image" value="Like"><img src="like.gif" alt="Like">
<input type="radio" name="t1image" value="Dont"><img src="dont.gif" alt="Don't Like">
<input type="radio" name="t1image" value="Hate"><img src="hate.gif" alt="Hate">
<input type="radio" name="t1image" value="Other"><img src="other.gif" alt="Other">
<br>
Why Title:<input type="text" name="t1title" size="45" value="..."/></td>
<td style="vertical-align: top;">
Explain:<br>
<textarea name="t1info" cols=45 rows=3 value="..."></textarea>
</td></tr></table>
<br>
<!--Next-->

How do I get the Form data to save to the php page for others to view?

I'm not sure why, but once I added a search form in my nav menu, it made my other forms on the website such as login and signup form take them to where the search button would take them. any ideas???

This topic has been moved to JavaScript Help.

http://www.phpfreaks.com/forums/index.php?topic=347360.0

Hi i am trying to change the query to sort by desc or asc I am using the switch method but the form is not calling the switch statment can someone help me out please?

this is the swicth script
Code: [Select]
switch ($sortby) {
    case "ASC":
        $args = array(
's' => $_GET['s'],
'post_type' => 'deals',
'orderby' => 'title',
'order' => 'ASC',
'paged' => get_query_var('paged')
);
    break;
    case "DESC":
                $args = array(
's' => $_GET['s'],
'post_type' => 'deals',
'orderby' => 'title',
'order' => 'DESC',
'paged' => get_query_var('paged')
);
        break;
}This is the form
Code: [Select]
<form name="myForm">
             <select id="sortby" >
                 <option value="ASC">ASC</option>
                 <option value="DESC">DESC</option>
            </select>
         </form>
I intend to use a onchange so that when depending on the option they select it will change the order?

Hi all,

What I am trying to achieve is, I thought quite simple!

Basically, a user signs up and chooses a package, form is submitted, details added to the database, email sent to customer, then I want to direct them to a paypal payment screen, this is where I am having issues!

Is their any way in php to submit a form without user interaction? Here is my code for the form process page
Code: [Select]
<?php
include('config.php');
require('scripts/class.phpmailer.php');

$package = $_POST['select1'];
$name = $_POST['name'];
$email = $_POST['email'];
$password = md5($_POST['password']);

$domain = $_POST['domain'];
$a_username = $_POST['a_username'];
$a_password = $_POST['a_password'];


$query=mysql_query("INSERT INTO orders (package, name, email, password, domain, a_username, a_password)
VALUES
('$package', '$name', '$email', '$password', '$domain', '$a_username', '$a_password')");

if (!$query)
{
echo "fail<br>";
echo mysql_error();
}

else
{
$id = mysql_insert_id();
$query1=mysql_query("INSERT INTO customers (id, name, email, password)
values
('$id', '$name', '$email', '$password')");

if (!$query1)
{
echo "fail<br>";
echo mysql_error();
}


if($package=="Reseller Hosting")
{

//email stuff here - all works - just cutting it to keep the code short


if(!$mail->Send())
{
   echo "Message could not be sent. <p>";
   echo "Mailer Error: " . $mail->ErrorInfo;
   exit;
}
?>


<form name="_xclick" action="https://www.paypal.com/cgi-bin/webscr" method="post">
<input type="hidden" name="cmd" value="_xclick-subscriptions">
<input type="hidden" name="business" value="subscription@jollyhosting.com">
<input type="hidden" name="currency_code" value="USD">
<input type="hidden" name="item_name" value="Jolly Hosting Reseller Packages">
<input type="hidden" name="no_shipping" value="1">

<!--1st month -->
<input type="hidden" name="currency_code" value="USD"> 
<input type="hidden" name="a3" value="3.00">
<input type="hidden" name="p3" value="1">
<input type="hidden" name="t3" value="M">
<input type="hidden" name="src" value="1">
<input type="hidden" name="sra" value="1">
</form>';


<?php
}

//last
}
//end
?>

Hi-
the code below lets me upload a CSV file to my database if I have 1 field in my database and 1 column in my CSV.
I need to add to my db "player_id" from the CVS file and "event_name" and "event_type" from the form... any ideas???

here's the code:
Code: [Select]
<?php
$hoststring =""; 
$database = "";
$username = "";
$password = "";
$makeconnection = mysql_pconnect($hoststring, $username, $password);
?>
<?php
ob_start();
mysql_select_db($database, $makeconnection);
$sql_get_players="
SELECT * 
FROM tabel 
ORDER BY player_id ASC";
//
$get_players = mysql_query($sql_get_players, $makeconnection) or die(mysql_error());
$row_get_players = mysql_fetch_assoc($get_players);
//
$message = null;
$allowed_extensions = array('csv');
$upload_path = '.'; //same directory

if (!empty($_FILES['file'])) {

if ($_FILES['file']['error'] == 0) {
// check extension
$file = explode(".", $_FILES['file']['name']);
$extension = array_pop($file);

if (in_array($extension, $allowed_extensions)) {

if (move_uploaded_file($_FILES['file']['tmp_name'], $upload_path.'/'.$_FILES['file']['name'])) {

if (($handle = fopen($upload_path.'/'.$_FILES['file']['name'], "r")) !== false) {
$keys = array();
$out = array();
$insert = array();
$line = 1;

while (($row = fgetcsv($handle, 0, ',', '"')) !== FALSE) {

foreach($row as $key => $value) {    

if ($line === 1) {
$keys[$key] = $value;       
} else {       
$out[$line][$key] = $value;              
}       
}                
$line++;          
}        

fclose($handle);            

if (!empty($keys) && !empty($out)) {        
$db = new PDO(
'mysql:host=host;dbname=db', 
'user', 
'pw');   

$db->exec("SET CHARACTER SET utf8");        

foreach($out as $key => $value) {        
$sql  = "INSERT INTO `table` (`";
$sql .= implode("`player_id`", $keys);    
$sql .= "`) VALUES (";    
$sql .= implode(", ", array_fill(0, count($keys), "?"));    
$sql .= ")";    
$statement = $db->prepare($sql);    
$statement->execute($value);       
}      

$message = '<span>File has been uploaded successfully</span>';      
}
}
}
} else {
$message = '<span>Only .csv file format is allowed</span>';
}
} else {
$message = '<span>There was a problem with your file</span>';
}
}
ob_flush();?>
<!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">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<title>CSV File Upload</title>
</head>
<body>

<form class="form" action="" method="post" enctype="multipart/form-data">
<h3>Select Your File</h3>
<p><?php echo $message; ?></p>
<input type="file" name="file" id="file" size="30" />
<br/>
<label>Event Name:</label><input name="event_name" type="text" value="" />
<br/>
<label>Event Type:</label><input name="event_type" type="text" value="" />
<br/>
<input type="submit" id="btn" class="button" value="Submit" />
</form>

<br/>
<h3>Results:</h3>
<?php do { ?>
<p><?php echo $row_get_players['player_id'];?></p>
<?php } while ($row_get_players = mysql_fetch_assoc($get_players)); ?>
</body>
</html>

Is jquery/Ajax better than real/raw PHP for form validation ?!

What if JavaScript is turned off on the browser?!

why after someone refreshing a page on the browser, the variables used to echo error after invalid data is being submitted will return the undefined variables error?!

And how to handle form validation including an empty form field, maximum amount of value entered and so on

Which one is better for standards practices in PHP.

1. Using the same form for everything. (Add and edit). Meaning setting up one form to handle adding new records, as well as editing existing records. 

Or

2. Using two different forms for both actions. Use one form/area to handle Adding, and one form/area to handle editing.

Which one of these are better from a standards/practice point of a view.  Which one better fits into the MVC platform (a framework like Codeignitor, or Cake).
Should their be separate controller functions/views for add and edit or should they all be in the same controller function/form.

Thanks for the feedback.

Hi,
how can i create a form within a form with the click of a button? so that when i click add new item, it brings form fields under the current one. hope my explanation helps

thanks

Code: [Select]
<form id="form1" name="form1" method="post" action="">
          <table width="100%" border="0" cellspacing="2" cellpadding="0">
            <tr>
              <td width="22%">Invoice Number </td>
              <td width="78%">&nbsp;</td>
            </tr>
            <tr>
              <td>Date Issued </td>
              <td>&nbsp;</td>
            </tr>
            <tr>
              <td colspan="2">&nbsp;</td>
              </tr>
            <tr>
              <td colspan="2"><table width="100%" border="0" cellspacing="2" cellpadding="0">
                <tr>
                  <td width="10%">Quantity</td>
                  <td width="70%">Description</td>
                  <td width="9%">Taxable</td>
                  <td width="11%">Amnount</td>
                </tr>
                <tr>
                  <td valign="top"><input name="textfield" type="text" size="7" /></td>
                  <td valign="top"><textarea name="textfield2" cols="80"></textarea></td>
                  <td valign="top"><input type="checkbox" name="checkbox" value="checkbox" /></td>
                  <td valign="top"><input name="textfield3" type="text" size="12" /></td>
                </tr>
                <tr>
                  <td colspan="4"><input type="submit" name="Submit" value="Add New Item" /></td>
                </tr>
              </table></td>
              </tr>
            <tr>
              <td colspan="2">&nbsp;</td>
            </tr>
            <tr>
              <td colspan="2">&nbsp;</td>
            </tr>
            <tr>
              <td colspan="2">&nbsp;</td>
            </tr>
          </table>
                </form>

As the topis says, I need help with an email form.
You must have valid email address to go further, so lets say you write asdada as email, you won't be able to register the account, you must have asdada@hotmai.com or something like that.

If anyone knows it would be awesome!