PHP - Simple Php/html Contact Form Giving Me Trouble. Any Advice?

Hello!

Everything on this form emails the way it should except for the checkboxes. The email simply states "Array" instead of what services are checked off. I don't understand PHP that well so I used a contact form and tried to modify it to include the checkboxes. Didn't work out Please help.



<?php
// OPTIONS - PLEASE CONFIGURE THESE BEFORE USE!

$yourEmail = "hello@mail"; // the email address you wish to receive these mails through
$yourWebsite = ""; // the name of your website
$thanksPage = ''; // URL to 'thanks for sending mail' page; leave empty to keep message on the same page
$maxPoints = 4; // max points a person can hit before it refuses to submit - recommend 4
$requiredFields = "name,email,comments"; // names of the fields you'd like to be required as a minimum, separate each field with a comma


// DO NOT EDIT BELOW HERE
$error_msg = null;
$result = null;

$requiredFields = explode(",", $requiredFields);

foreach($_POST["service"]  as  $value)  {
$service .= "$value\n";
}

function clean($data) {
   $data = trim(stripslashes(strip_tags($data)));
   return $data;
}
function isBot() {
   $bots = array("Indy", "Blaiz", "Java", "libwww-perl", "Python", "OutfoxBot", "User-Agent", "PycURL", "AlphaServer", "T8Abot", "Syntryx", "WinHttp", "WebBandit", "nicebot", "Teoma", "alexa", "froogle", "inktomi", "looksmart", "URL_Spider_SQL", "Firefly", "NationalDirectory", "Ask Jeeves", "TECNOSEEK", "InfoSeek", "WebFindBot", "girafabot", "crawler", "www.galaxy.com", "Googlebot", "Scooter", "Slurp", "appie", "FAST", "WebBug", "Spade", "ZyBorg", "rabaz");

   foreach ($bots as $bot)
      if (stripos($_SERVER['HTTP_USER_AGENT'], $bot) !== false)
         return true;

   if (empty($_SERVER['HTTP_USER_AGENT']) || $_SERVER['HTTP_USER_AGENT'] == " ")
      return true;
   
   return false;
}

if ($_SERVER['REQUEST_METHOD'] == "POST") {
   if (isBot() !== false)
      $error_msg .= "No bots please! UA reported as: ".$_SERVER['HTTP_USER_AGENT'];
      
   // lets check a few things - not enough to trigger an error on their own, but worth assigning a spam score..
   // score quickly adds up therefore allowing genuine users with 'accidental' score through but cutting out real spam
   $points = (int)0;
   
   $badwords = array("adult", "beastial", "bestial", "blowjob", "clit", "cum", "cunilingus", "cunillingus", "cunnilingus", "cunt", "ejaculate", "fag", "felatio", "fellatio", "fuck", "fuk", "fuks", "gangbang", "gangbanged", "gangbangs", "hotsex", "hardcode", "jism", "jiz", "orgasim", "orgasims", "orgasm", "orgasms", "phonesex", "phuk", "phuq", "pussies", "pussy", "spunk", "xxx", "viagra", "phentermine", "tramadol", "adipex", "advai", "alprazolam", "ambien", "ambian", "amoxicillin", "antivert", "blackjack", "backgammon", "texas", "holdem", "poker", "carisoprodol", "ciara", "ciprofloxacin", "debt", "dating", "porn", "link=", "voyeur", "content-type", "bcc:", "cc:", "document.cookie", "onclick", "onload", "javascript");

   foreach ($badwords as $word)
      if (
         strpos(strtolower($_POST['comments']), $word) !== false ||
         strpos(strtolower($_POST['name']), $word) !== false
      )
         $points += 2;
   
   if (strpos($_POST['comments'], "http://") !== false || strpos($_POST['comments'], "www.") !== false)
      $points += 2;
   if (isset($_POST['nojs']))
      $points += 1;
   if (preg_match("/(<.*>)/i", $_POST['comments']))
      $points += 2;
   if (strlen($_POST['name']) < 3)
      $points += 1;
   if (strlen($_POST['comments']) < 15 || strlen($_POST['comments'] > 1500))
      $points += 2;
   // end score assignments

   foreach($requiredFields as $field) {
      trim($_POST[$field]);
      
      if (!isset($_POST[$field]) || empty($_POST[$field]))
         $error_msg .= "Please fill in all the required fields and submit again.\r\n";
   }

   if (!preg_match("/^[a-zA-Z-'\s]*$/", stripslashes($_POST['name'])))
      $error_msg .= "The name field must not contain special characters.\r\n";
   if (!preg_match('/^([a-z0-9])(([-a-z0-9._])*([a-z0-9]))*\@([a-z0-9])(([a-z0-9-])*([a-z0-9]))+' . '(\.([a-z0-9])([-a-z0-9_-])?([a-z0-9])+)+$/i', strtolower($_POST['email'])))
      $error_msg .= "That is not a valid e-mail address.\r\n";
   if (!empty($_POST['url']) && !preg_match('/^(http|https):\/\/(([A-Z0-9][A-Z0-9_-]*)(\.[A-Z0-9][A-Z0-9_-]*)+)(\d+))?\/?/i', $_POST['url']))
      $error_msg .= "Invalid website url.\r\n";
   
   if ($error_msg == NULL && $points <= $maxPoints) {
      $subject = "Automatic Form Email";
      
      $message = "You received this e-mail message through your website: \n\n";
      foreach ($_POST as $key => $val) {
         $message .= ucwords($key) . ": " . clean($val) . "\r\n";
      }
      $message .= "\r\n";
      $message .= 'IP: '.$_SERVER['REMOTE_ADDR']."\r\n";
      $message .= 'Browser: '.$_SERVER['HTTP_USER_AGENT']."\r\n";
      $message .= 'Points: '.$points;

      if (strstr($_SERVER['SERVER_SOFTWARE'], "Win")) {
         $headers   = "From: $yourEmail\n";
         $headers  .= "Reply-To: {$_POST['email']}";
      } else {
         $headers   = "From: $yourWebsite <$yourEmail>\n";
         $headers  .= "Reply-To: {$_POST['email']}";
      }

      if (mail($yourEmail,$subject,$message,$headers)) {
         if (!empty($thanksPage)) {
            header("Location: $thanksPage");
            exit;
         } else {
            $result = 'Thank You! Your email was successfully sent.';
            $disable = true;
         }
      } else {
         $error_msg = 'Your mail could not be sent this time. ['.$points.']';
      }
   } else {
      if (empty($error_msg))
         $error_msg = 'Your mail looks too much like spam, and could not be sent this time. ['.$points.']';
   }
}
function get_data($var) {
   if (isset($_POST[$var]))
      echo htmlspecialchars($_POST[$var]);
}

?>


<!DOCTYPE html>
<html lang="en">
<head>
      <title>Contact Us</title>
      <meta charset="utf-8">
     
      <link rel="stylesheet" href="css/reset.css" type="text/css" media="all">
      <link rel="stylesheet" href="css/style.css" type="text/css" media="all">
     
      <script type="text/javascript" src="js/jquery-1.4.2.min.js" ></script>
      <script type="text/javascript" src="js/cufon-yui.js"></script>
      <script type="text/javascript" src="js/Humanst521_BT_400.font.js"></script>
      <script type="text/javascript" src="js/Humanst521_Lt_BT_400.font.js"></script>
      <script type="text/javascript" src="js/cufon-replace.js"></script>
      <script type="text/javascript" src="js/roundabout.js"></script>
      <script type="text/javascript" src="js/roundabout_shapes.js"></script>
      <script type="text/javascript" src="js/gallery_init.js"></script>
     
      <!--[if lt IE 7]>
        <link rel="stylesheet" href="css/ie/ie6.css" type="text/css" media="all">
      <![endif]-->
      <!--[if lt IE 9]>
        <script type="text/javascript" src="js/html5.js"></script>
        <script type="text/javascript" src="js/IE9.js"></script>
      <![endif]-->
     
</head>

<body>
  <!-- header -->
  <header>
    <div class="container">
       <h1><a href="index.html"></a></h1>
      <nav>
        <ul>
           <li><a href="index.html">Home</a></li>
             <li><a href="aboutpg/about.html">About</a></li>
            <li><a href="currentpg/current.html">Current</a></li>
             <li><a href="contact.php" class="current">Contact</a></li>
        </ul>
      </nav>
    </div>
   </header>
  <!-- #gallery -->
  <section id="gallery">
     <div class="container">
       <ul id="myRoundabout">
         <li><img src="images/postcard.jpg"></li>
      </ul>
     </div>
  </section>
  <!-- /#gallery -->
  <div class="main-box">
    <div class="container">
      <div class="inside">
        <div class="wrapper">
           <!-- aside -->
          <aside>
            <h2>Contact <span></span></h2>
            <!-- .contacts -->
            <ul class="contacts">
              <li><strong>Owner:</strong></li>
              <li><strong>Business:</strong></li>
              <li><strong>Address:</strong></li>
              <li><strong>&nbsp;</strong></li>
              <li><strong>Phone:</strong></li>
              <li><strong>Email:</strong>      
           <script type="text/javascript">
/*<![CDATA[*/

/***********************************************
* Encrypt Email script- Please keep notice intact
* Tool URL: http://www.dynamicdrive.com/emailriddler/
* **********************************************/
<!-- Encrypted version of:  [at] *****.*** //-->

var emailriddlerarray=[83,80,87,105,110,99,55,55,64,121,97,104,111,111,46,99,111,109]
var encryptedemail_id20='' //variable to contain encrypted email
for (var i=0; i<emailriddlerarray.length; i++)
 encryptedemail_id20+=String.fromCharCode(emailriddlerarray)

document.write('<a href="mailto:'+encryptedemail_id20+'"></a>')

/*]]>*/
</script></li>
            </ul>
            <!-- /.contacts -->
            <h3>Miscellaneous info:</h3>
            <p><a href="http://www.fireislandferries.com" target="_blank">Fire Island Ferries</a></p>
         <p><a href="http://www.googlemaps.com" target="_blank">Google Maps</a></p>
         <p><a href="http://www.fireislandnews.net" target="_blank">Fire Island News</a></p>
         <p><a href="http://www.fireislandtide.net" target="_blank">Fire Island Tide</a></p>

          </aside>
          <!-- content -->
          <section id="content">
            <article>
               <h2><span>*All fields are required.</span></h2>
<?php
if ($error_msg != NULL) {
   echo '<p class="error">ERROR: '. nl2br($error_msg) . "</p>";
}
if ($result != NULL) {
   echo '<p class="success">'. $result . "</p>";
}
?>

<form action="<?php echo basename(__FILE__); ?>" method="post">
<noscript>
      <p><input type="hidden" name="nojs" id="nojs" /></p>
</noscript>

                 <label>Services Required (check off as many as required):</label>
                   <br>
                       <input type="checkbox" name="service[ ]" id="service_0" value="addition" align="right">Addition<br>
                  <input type="checkbox" name="service[ ]" id="service_1" value="remodeling">Remodeling<br>
                        <input type="checkbox" name="service[ ]" id="service_2" value="roof">Roof<br>
                        <input type="checkbox" name="service[ ]" id="service_3" value="foundation">Foundation<br>
                 <input type="checkbox" name="service[ ]" id="service_4" value="kitchen">Kitchen<br>
                        <input type="checkbox" name="service[ ]" id="service_5" value="bath">Bath(s)<br>
                        <input type="checkbox" name="service[ ]" id="service_6" value="tile">Tile Work<br>
                        <input type="checkbox" name="service[ ]" id="service_7" value="window">Windows<br>
                        <input type="checkbox" name="service[ ]" id="service_8" value="deck">Deck<br>
                        <input type="checkbox" name="service[ ]" id="service_9" value="painting">Painting<br>
                        <input type="checkbox" name="service[ ]" id="service_10" value="power washing">Power Washing<br>
                        <input type="checkbox" name="service[ ]" id="service_11" value="opening closing">Spring Opening/Fall Closing
                        <br><br>

   <br />
            <p>
              <small>Name: </small><input type="text" name="name" id="name" value="<?php get_data("name"); ?>" size="22" placeholder="First Last"/>
              <label for="name"></label>
            </p>
            <p>
              <small>Phone: </small><input type="text" name="email" id="email" value="<?php get_data("phone"); ?>" size="22" placeholder="(123) 123-4567"/>
              <label for="phone"></label>
            </p>
            <p>
              <small>Email: </small><input type="text" name="email" id="email" value="<?php get_data("email"); ?>" size="22" placeholder="you@email.com"/>
              <label for="email"></label>
            </p>
            <p>
              <small>Message: </small><textarea name="comments" id="comments" placeholder="Please write a brief message here."><?php get_data("comments"); ?></textarea>
              <label for="comments" style="display:none;"></label>
            </p>
            <p>
              <input name="submit" type="submit" id="submit" value="Submit Form"  <?php if (isset($disable) && $disable === true) echo ' disabled="disabled"'; ?> />
              &nbsp;
            </p>
          </form>

      </div>
            </article>
          </section>
        </div>
      </div>
    </div>
  </div>

  <script type="text/javascript"> Cufon.now(); </script>
</body>
</html>

Hi,

Today I have taken my first step towards familiarisation with php.

I have created a simple form form a tutorial I read.

The mail.php file is this:

Code: [Select]
<?php
$firstname = $_POST['firstname'];
$lastname = $_POST['lastname'];
$email = $_POST['email'];
$dropdown = $_POST['dropdown'];
$formcontent=" From: $firstname \n Surname: $lastname \n Email: $email \n Dropdown: $dropdown";
$recipient = "fathernugen@googlemail.com";
$subject = "Newsletter Sign Up";
$mailheader = "From: $email \r\n";
mail($recipient, $subject, $formcontent, $mailheader) or die("Error!");
echo "You have been added to our newsletter subscription list!" . " -" . "<a href='newsletter.php' style='margin:0 auto; top: 100px; text-decoration:none;color:#ff0099;'> Return to Sitting Spiritually</a>";
?>

My problem is that users are redirected to a blank page with 'thank you return to sitting spiritually'.

I would like to use a custom thank you page with a url like;

www.sittingspiritually.co.uk/thankyou.php

so the look of the site is not completely ruined by my php inadequacies.


Is there a small piece of code i can add to the mail.php file so i can use a custom page for the success???

I hope some one can help, thanks in advance.

Hello, I am trying to use this contact form that emails out. however it wants to be placed beside the file that uses it. However i would need a bunch of these files than for what i am trying to do.

I want it to be set up like this.

website root
|
|
scripts
|
scriptfile

right now its like this

website root
|
|
about
|
|
contact
|
|
script file


here is the from data in my webpage

<form action="FormToEmail.php" method="post">
<table border="0" style="background:#ececec" cellspacing="5">
<tr align="left"><td>Name</td><td><input type="text" size="30" name="name"></td></tr>
<tr align="left"><td>Email address</td><td><input type="text" size="30" name="email"></td></tr>
<tr align="left"><td valign="top">Comments</td><td><textarea name="comments" rows="6" cols="30"></textarea></td></tr>
<tr align="left"><td>&nbsp;</td><td><input type="submit" value="Send"></td></tr>
</table>
</form>


here is the script data
<?php

error_reporting(E_ALL ^ E_NOTICE);



$my_email = "test@test.com.com";



$from_email = "";

/*

Optional.  Enter the continue link to offer the user after the form is sent.  If you do not change this, your visitor will be given a continue link to your homepage.

If you do change it, remove the "/" symbol below and replace with the name of the page to link to, eg: "mypage.htm" or "http://www.elsewhere.com/page.htm"

*/

$continue = "/";

/*

Step 3:

Save this file (FormToEmail.php) and upload it together with your webpage containing the form to your webspace.  IMPORTANT - The file name is case sensitive!  You must save it exactly as it is named above!

THAT'S IT, FINISHED!

You do not need to make any changes below this line.

*/

$errors = array();

// Remove $_COOKIE elements from $_REQUEST.

if(count($_COOKIE)){foreach(array_keys($_COOKIE) as $value){unset($_REQUEST[$value]);}}

// Validate email field.

if(isset($_REQUEST['email']) && !empty($_REQUEST['email']))
{

$_REQUEST['email'] = trim($_REQUEST['email']);

if(substr_count($_REQUEST['email'],"@") != 1 || stristr($_REQUEST['email']," ") || stristr($_REQUEST['email'],"\\") || stristr($_REQUEST['email'],":")){$errors[] = "Email address is invalid";}else{$exploded_email = explode("@",$_REQUEST['email']);if(empty($exploded_email[0]) || strlen($exploded_email[0]) > 64 || empty($exploded_email[1])){$errors[] = "Email address is invalid";}else{if(substr_count($exploded_email[1],".") == 0){$errors[] = "Email address is invalid";}else{$exploded_domain = explode(".",$exploded_email[1]);if(in_array("",$exploded_domain)){$errors[] = "Email address is invalid";}else{foreach($exploded_domain as $value){if(strlen($value) > 63 || !preg_match('/^[a-z0-9-]+$/i',$value)){$errors[] = "Email address is invalid"; break;}}}}}}

}

// Check referrer is from same site.

if(!(isset($_SERVER['HTTP_REFERER']) && !empty($_SERVER['HTTP_REFERER']) && stristr($_SERVER['HTTP_REFERER'],$_SERVER['HTTP_HOST']))){$errors[] = "You must enable referrer logging to use the form";}

// Check for a blank form.

function recursive_array_check_blank($element_value)
{

global $set;

if(!is_array($element_value)){if(!empty($element_value)){$set = 1;}}
else
{

foreach($element_value as $value){if($set){break;} recursive_array_check_blank($value);}

}

}

recursive_array_check_blank($_REQUEST);

if(!$set){$errors[] = "You cannot send a blank form";}

unset($set);

// Display any errors and exit if errors exist.

if(count($errors)){foreach($errors as $value){print "$value<br>";} exit;}

if(!defined("PHP_EOL")){define("PHP_EOL", strtoupper(substr(PHP_OS,0,3) == "WIN") ? "\r\n" : "\n");}

// Build message.

function build_message($request_input){if(!isset($message_output)){$message_output ="";}if(!is_array($request_input)){$message_output = $request_input;}else{foreach($request_input as $key => $value){if(!empty($value)){if(!is_numeric($key)){$message_output .= str_replace("_"," ",ucfirst($key)).": ".build_message($value).PHP_EOL.PHP_EOL;}else{$message_output .= build_message($value).", ";}}}}return rtrim($message_output,", ");}

$message = build_message($_REQUEST);

$message = $message . PHP_EOL.PHP_EOL."-- ".PHP_EOL."";

$message = stripslashes($message);

$subject = "Doctor Dave Question";

$subject = stripslashes($subject);

if($from_email)
{

$headers = "From: " . $from_email;
$headers .= PHP_EOL;
$headers .= "Reply-To: " . $_REQUEST['email'];

}
else
{

$from_name = "";

if(isset($_REQUEST['name']) && !empty($_REQUEST['name'])){$from_name = stripslashes($_REQUEST['name']);}

$headers = "From: {$from_name} <{$_REQUEST['email']}>";

}

mail($my_email,$subject,$message,$headers);

?>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">

<html>

<head>
<title>Form To Email PHP script from FormToEmail.com</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>

<body bgcolor="#ffffff" text="#000000">

<div>
<center>
<b>Thank you <?php if(isset($_REQUEST['name'])){print stripslashes($_REQUEST['name']);} ?></b>
<br>Your message has been sent
<p><a href="<?php print $continue; ?>">Click here to continue</a></p>
</center>
</div>

</body>
</html>


thank you.

on a side note the text box wher ei entered this in is anoyying. it jumps and bounces every letter i type.

Hello, I have just finished very simple contact form at http://stjohnsclaims.co.uk/test5/index-6.html and I am strugling to redirect the page to index.html, or any other URL when buttom "submit" is pressed.  html file always reads contact.php file and then echo ("Your claim form was successfully sent!"); on blank background. How can I redirect it? I know this is very trivial question, but I have alrready spend many hours trying to fix it with no result. Thank you


html body....


<div class="indent1">
                               <h2>Claim Form</h2>
                                <form action="contact.php" method="get" id="form"><div class="container">
                                   <div class="col-5"><h4>Your Details:</h4>
                                       <div class="h"><input name="name" type="text" class="input1" />Name:</div>
                                       <div class="h"><input name="surname"type="text" class="input1" />Surname:</div>
                                       <div class="h"><input name="tel"type="text" class="input1" />Tel:</div>
                                                        <div class="h"><input name="email"type="text" class="input1" />Email Adress:</div>                                        
                                                        <div class="h"><input name="address"type="text" class="input1" />Address:</div>                                        
                                       <div class="h"><input name="city"type="text" class="input1" />City:</div>
                                       <div class="h"><input name="postcode"type="text" class="input1" />Postcode:</div><p>
                                       <h4>Accident Details</h4>   
                                      <div class="h"><input name="date"type="text" class="input1" />Date of Accident:</div>
                                       <div class="h"><input name="type"type="text" class="input1" />Accident Type:</div>
                                          
   

                                    </div>

                                   <div class="col-6">Accident details/Injuries sustained:</div>

                                   <div class="col-7">
                                       <textarea name="message" class="textarea" rows="40" cols="30"></textarea>

                                        <div class="container1">
                                            <div class="fright">
<a href="#" onclick="document.getElementById('form').reset()" class="link-1"><em><b>Clear</b></em></a>
                                               <div class="indent-2">
<a href="#" onclick="document.getElementById('form').submit()" class="link-1"><em><b>Submit</b></em></a></div>
                                            </div>
                                        </div>
                                    </div>
                                </div></form>

---------------------------------------------------------------
contact.php on the server


<?
$subject="from ".$_GET['name'];
$headers= "From: ".$_GET['email']."\n";
 $headers.='Content-type: text/html; charset=iso-8859-1';
mail("kc@kamil-cizek.com", $subject,  "
<html>
<head>
 <title>Contact letter</title>
</head>
<body>



<br>
 
 
"
. "name: " .$_GET['name']. "<br>"
. "email: " .$_GET['surname']. "<br>"
. "fax: " .$_GET['tel']. "<br>"
. "age: " .$_GET['email']. "<br>"
. "gender: " .$_GET['address']. "<br>"
. "name: " .$_GET['city']. "<br>"
. "email: " .$_GET['postcode']. "<p>"
. "fax: " .$_GET['date']. "<br>"
. "age: " .$_GET['type']. "<p>"


. "message: <p>" .$_GET['message']."
 
 
</body>
</html>" , $headers);

echo ("Your claim form was successfully sent!");


?>

so, I've been trying to build a contact form for about a week now. straight. no kidding.
I'm entirely new to php and basically know nothing more than i can assume based on other scripting/coding experience.
I know there's probably answers to similar questions all over the place, but I've been trying literally hundreds of different pre-built forms guaranteed to work and solutions to others' problems, etc etc and not a single one has operated correctly for me. I can't really do anything with a "you should try this/that approach" answer, nor can I be assumed to know anything about php; I pretty much just need someone to fix whatever the problem is and paste it back to me as this is the only thing keeping me from launching the site.

this is what prints when trying to submit with the dropdown on the default value:
Quote

Warning: mail() [function.mail]: SMTP server response: 451 See http://pobox.com/~djb/docs/smtplf.html. in D:\Hosting\5810110\html\contact\contact.php on line 32
There was an err0r processing your request. Please notify god@neurot1k.com & include details of what you did [wrong].


this prints when any item other than the default is selected in the dropdown:
Quote

Warning: mail() [function.mail]: SMTP server response: 451 See http://pobox.com/~djb/docs/smtplf.html. in D:\Hosting\5810110\html\contact\contact.php on line 32

Warning: mail() [function.mail]: SMTP server response: 554 The message was rejected because it contains prohibited virus or spam content in D:\Hosting\5810110\html\contact\contact.php on line 33
There was an err0r processing your request. Please notify god@neurot1k.com & include details of what you did [wrong].


http://email.about.com/cs/standards/a/smtp_error_code_2.htm specifically states to ignore both these errors, yet http://cr.yp.to/docs/smtplf.html specifically states that it's a fault of mine.

here's the html:
Code: [Select]
<div id="formHolder">
<form method="post" action="contact.php">
<table class="contactTable" align="center">
  <tr>
    <td>
    Subject:
    </td>
    <td>
    <select name="sendto">
    <option value="bs from N1K.com">General Inquiry</option>
    <option value="JOB OFFER">Design Contract</option>
    <option value="PURCHASE ORDER">Purchase Order/Offer</option>
    </select>
    </td>
  </tr>
  <tr>
    <td><font color=red>*</font>Name:</td>
    <td><input size=25 name="Name"></td>
  </tr>
  <tr>
    <td><font color=red>*</font>Email:</td>
    <td><input size=25 name="Email"></td>
  </tr>
  <tr>
    <td>Company:</td>
  <td><input size=25 name="Company"></td>
  </tr>
  <tr>
    <td>Phone:</td>
    <td><input size=25 name="Phone"></td>
  </tr>
  <tr>
    <td>Subscribe to<br>
     mailing list:
    </td>
    <td><input type="radio" name="list" value="No"> Pf, nothx.<br>
    <input type="radio" name="list" value="Yes" checked> H3X Y34!<br>
</td>
  </tr>
  <tr>
    <td colspan=2>Message:</td>
  </tr>
  <tr>
    <td colspan=2 align=center>
    <textarea name="Message" rows=5 cols=35></textarea>
    </td>
  </tr>
  <tr>
    <td colspan=2 align=center>
    <input type=submit name="send" value="Submit">
    </td>
  </tr>
</table>
</form>
</div><!-- END formHolder -->

and here's the php:
 <?php
 
 $to = "god@neurot1k.com" ;
 $from = $_REQUEST['Email'] ;
 $name = $_REQUEST['Name'] ;
 $headers = "From: $from";
 $subject = $_REQUEST['sendto'] ;
 
 $fields = array();
 $fields{"Name"} = "Name";
 $fields{"Company"} = "Company";
 $fields{"Email"} = "Email";
 $fields{"Phone"} = "Phone";
 $fields{"list"} = "Mailing List";
 $fields{"Message"} = "Message";
 
 $body = "I have received the following information:\n\n";
 foreach($fields as $a => $b){
   $body .= sprintf("%20s: %s\n",$b,$_REQUEST[$a]);
    }

   $headers2 = "From: god@neurot1k.com";
   $subject2 = "autoconfirm from neurot1k.com";
   $autoreply = "Thanks for the contact, I'll get back to you as soon as possible, usually within 48 hours. If you have any more questions, please try me on AIM: ycleptCrux";

   if($from == '') {
   print "You have not entered an email, please go back and try again";
   } else {
    if($name == '') {
   print "You have not entered a name, please go back and try again";
   } else {
   $send = mail($to, $subject, $body, $headers);
   $send2 = mail($from, $subject2, $autoreply, $headers2);
   if($send) {
   print "Thanks, I'll get back to you as soon as possible.";
   } else {
   print "There was an err0r processing your request. Please notify god@neurot1k.com & include details of what you did [wrong].";
   }
   }
   }
?>


the form was copy/pasted from http://php.about.com/od/phpapplications/ss/form_mail.htm and then respective variables were changed (email address, dropdown fields, etc). I didn't think it'd be SUCH a problem to copy/paste a pre-written block of code from About.com...

HUGE thanks in advance to anyone willing to helo.