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<?php
require_once "../formvalidator.php";
if(isset($_POST['Submit']))
{
$validator = new FormValidator();
$validator->addValidation("nam","req","<a onclick=\"document.getElementById('nam').style.color='red'\">Full Name</a>");
$validator->addValidation("eml","email","<a onclick=\"document.getElementById('eml').style.color='red'\">Please enter a valid email</a>");
$validator->addValidation("eml","req","<a onclick=\"document.getElementById('eml').style.color='red'\">Valid Email Address</a>");
$validator->addValidation("ph3","req","<a onclick=\"document.getElementById('phn').style.color='red'\">Current Valid Phone</a>");
$validator->addValidation("mes","req","<a onclick=\"document.getElementById('mes').style.color='red'\">Message</a>");
if($validator->ValidateForm())
{
//$to = "etoddt@gmail.com";
$to = "support@americansocietyforassetprotection.com, support@americansocietyap.org";
//$to = "name@domain.com" . ', ';
//$to .= "name@domain.asia";
$headers = 'From: American Society for Asset Protection <support@americansocietyforassetprotection.com>' . "\r\n";
$co = "American Society for Asset Protection";
$co2 = "American Society for Asset Protection <support@americansocietyforassetprotection.com>";
$nam = $_POST['nam'];
$eml = $_POST['eml'];
$ph1 = $_POST['ph1'];
$ph2 = $_POST['ph2'];
$ph3 = $_POST['ph3'];
$sub = $_POST['sub'];
$add = $_POST['add'];
$cit = $_POST['cit'];
$mes = $_POST['mes'];
$dat = date("F j, Y, g:i A");
$body ="
American Society for Asset Protection - Contact Page: $dat.\n
From: $nam
E-Mail: $eml
Phone: ($ph1) $ph2-$ph3
Address:$add
$cit, $sub
Message:
$mes
";
$body2 ="
Thank you for your interest in American Society for Asset Protection (ASAP) \n
We received your email on $dat and are processing your inquiry.\n
An ASAP representative will respond within 24-48 hours.\n\n
Below is a copy of the information we receieved.\n
From: $nam
E-Mail: $eml
Phone: ($ph1) $ph2-$ph3
Address:$add
$cit, $sub
Message:
$mes\n
NOTE: DO NOT RESPOND TO THIS EMAIL.\n
Please send all email correspondence to support@americansocietyforassetprotection.com\n
";
if(mail($to, $co, $body, "From: $co2")){
mail($eml, $co, $body2, $headers);
$output = '<p class="success"><b>THANK YOU FOR YOUR EMAIL!</b> Please allow 24-48 hours for a representative to contact you regarding your inquiry.</p>';
$reset = 'reset';
}
} else {
$output .= "<p class='error'>";
$output .= "<b>SORRY -</b> We need you to input";
$error_hash = $validator->GetErrors();
foreach($error_hash as $inpname => $inp_err)
{
$output .= ", $inp_err";
}
$output .= "</p>";
}
}
$body_id = 'conct';
$title = 'Secure Contact Form';
require_once('header.php');
?>
<div class="content_">
<h1 class="contact_header"><?php echo $title;?></h1>
<script type="text/javascript" language="javascript">
<!--
function css_browser_selector(u){var ua=u.toLowerCase(),is=function(t){return ua.indexOf(t)>-1},g='gecko',w='webkit',s='safari',o='opera',m='mobile',h=document.documentElement,b=[(!(/opera|webtv/i.test(ua))&&/msie\s(\d)/.test(ua))?('ie ie'+RegExp.$1):is('firefox/2')?g+' ff2':is('firefox/3.5')?g+' ff3 ff3_5':is('firefox/3.6')?g+' ff3 ff3_6':is('firefox/3')?g+' ff3':is('gecko/')?g:is('opera')?o+(/version\/(\d+)/.test(ua)?' '+o+RegExp.$1:(/opera(\s|\/)(\d+)/.test(ua)?' '+o+RegExp.$2:'')):is('konqueror')?'konqueror':is('blackberry')?m+' blackberry':is('android')?m+' android':is('chrome')?w+' chrome':is('iron')?w+' iron':is('applewebkit/')?w+' '+s+(/version\/(\d+)/.test(ua)?' '+s+RegExp.$1:''):is('mozilla/')?g:'',is('j2me')?m+' j2me':is('iphone')?m+' iphone':is('ipod')?m+' ipod':is('ipad')?m+' ipad':is('mac')?'mac':is('darwin')?'mac':is('webtv')?'webtv':is('win')?'win'+(is('windows nt 6.0')?' vista':''):is('freebsd')?'freebsd':(is('x11')||is('linux'))?'linux':'','js']; c = b.join(' '); h.className += ' '+c; return c;}; css_browser_selector(navigator.userAgent);
-->
</script>
<form name="dform" id="dform" method="post" action="" accept-charset="UTF-8">
<input type="hidden" id="check" value="<?php print $reset?>" onclick="javscript:return clearForms();" />
<center>
<table cellpadding="6" cellspacing="0" border="0" class="form">
<tr>
<td colspan="4"><?php print $output;?></td>
</tr>
<tr>
<td id="nam" class="required">Full Name</td>
<td><input name="nam" type="text" onblur="javascript:return valName('dform','nam')"
onfocus="this.style.color=focci; this.style.borderColor=focci"
value="<?php if (isset($_POST['nam'])){echo htmlspecialchars($_POST['nam'], ENT_QUOTES);}?>" /></td>
<td rowspan="6"></td>
<td id="mes" class="required">Message</td>
</tr>
<tr>
<td id="eml" class="required">Email Address</td>
<td><input name="eml" type="text"onblur="javascript:return valEmail('dform','eml')"
onfocus="this.style.color=focci; this.style.borderColor=focci"
value="<?php if (isset($_POST['eml'])){echo htmlspecialchars($_POST['eml'], ENT_QUOTES);}?>" /></td>
<td rowspan="5"><textarea name="mes" onblur="this.style.color=suces; this.style.borderColor=suces"
onfocus="this.style.color=focci; this.style.borderColor=focci" class="input_text"><?php if (isset($_POST['mes'])){echo htmlspecialchars($_POST['mes'], ENT_QUOTES);}?></textarea></td>
</tr>
<tr>
<td id="phn" class="required">Phone</td>
<td class="left"><input name="ph1" maxlength="3" type="text" class="phn" onKeyDown="TabNext(this,'down',3)"
onblur="valNum(this)" onfocus="this.style.color=focci; this.style.borderColor=focci"
onKeyUp="TabNext(this,'up',3,this.form.ph2)"
value="<?php if (isset($_POST['ph1'])){echo htmlspecialchars($_POST['ph1'], ENT_QUOTES);}?>" />
<input name="ph2" maxlength="3" type="text" class="phn" onKeyDown="TabNext(this,'down',3)"
onblur="valNum(this)" onfocus="this.style.color=focci; this.style.borderColor=focci"
onKeyUp="TabNext(this,'up',3,this.form.ph3)"
value="<?php if (isset($_POST['ph2'])){echo htmlspecialchars($_POST['ph2'], ENT_QUOTES);}?>" />
<input name="ph3" maxlength="4" type="text" class="phn2"
onblur="valNum(this)" onfocus="this.style.color=focci; this.style.borderColor=focci"
value="<?php if (isset($_POST['ph3'])){echo htmlspecialchars($_POST['ph3'], ENT_QUOTES);}?>" />
</td>
</tr>
<tr>
<td id="add">Address</td>
<td><input name="add" type="text" onblur="this.style.color=suces; this.style.borderColor=suces" onfocus="this.style.color=focci; this.style.borderColor=focci" value="<?php if (isset($_POST['add'])){echo htmlspecialchars($_POST['add'], ENT_QUOTES);}?>" /></td>
</tr>
<tr>
<td id="cit">City</td>
<td><input name="cit" type="text" onblur="this.style.color=suces; this.style.borderColor=suces" onfocus="this.style.color=focci; this.style.borderColor=focci" value="<?php if (isset($_POST['cit'])){echo htmlspecialchars($_POST['cit'], ENT_QUOTES);}?>" /></td>
</tr>
<tr>
<td id="sta">State</td>
<td class="left"><select id="sub" name="sub" onblur="this.style.color=suces; this.style.borderColor=suces" onfocus="this.style.color=focci; this.style.borderColor=focci"
onChange="if (dform.sub[dform.sub.selectedIndex].value === '') {alert('Please choose an option.'); return false;};">
<option value="" selected="selected"></option>
<option value="AL" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'AL') {echo 'selected="selected"';} ?>>AL</option>
<option value="AK" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'AK') {echo 'selected="selected"';} ?>>AK</option>
<option value="AZ" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'AZ') {echo 'selected="selected"';} ?>>AZ</option>
<option value="AR" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'AR') {echo 'selected="selected"';} ?>>AR</option>
<option value="CA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'CA') {echo 'selected="selected"';} ?>>CA</option>
<option value="CO" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'CO') {echo 'selected="selected"';} ?>>CO</option>
<option value="CT" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'CT') {echo 'selected="selected"';} ?>>CT</option>
<option value="DE" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'DE') {echo 'selected="selected"';} ?>>DE</option>
<option value="DC" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'DE') {echo 'selected="selected"';} ?>>DC</option>
<option value="FL" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'FL') {echo 'selected="selected"';} ?>>FL</option>
<option value="GA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'GA') {echo 'selected="selected"';} ?>>GA</option>
<option value="HI" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'HI') {echo 'selected="selected"';} ?>>HI</option>
<option value="ID" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'ID') {echo 'selected="selected"';} ?>>ID</option>
<option value="IL" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'IL') {echo 'selected="selected"';} ?>>IL</option>
<option value="IN" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'IN') {echo 'selected="selected"';} ?>>IN</option>
<option value="IA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'IA') {echo 'selected="selected"';} ?>>IA</option>
<option value="KS" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'KS') {echo 'selected="selected"';} ?>>KS</option>
<option value="KY" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'KY') {echo 'selected="selected"';} ?>>KY</option>
<option value="LA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'LA') {echo 'selected="selected"';} ?>>LA</option>
<option value="ME" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'ME') {echo 'selected="selected"';} ?>>ME</option>
<option value="MD" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MD') {echo 'selected="selected"';} ?>>MD</option>
<option value="MA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MA') {echo 'selected="selected"';} ?>>MA</option>
<option value="MI" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MI') {echo 'selected="selected"';} ?>>MI</option>
<option value="MN" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MN') {echo 'selected="selected"';} ?>>MN</option>
<option value="MS" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MS') {echo 'selected="selected"';} ?>>MS</option>
<option value="MO" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MO') {echo 'selected="selected"';} ?>>MO</option>
<option value="MT" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'MT') {echo 'selected="selected"';} ?>>MT</option>
<option value="NE" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NE') {echo 'selected="selected"';} ?>>NE</option>
<option value="NV" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NV') {echo 'selected="selected"';} ?>>NV</option>
<option value="NH" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NH') {echo 'selected="selected"';} ?>>NH</option>
<option value="NJ" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NJ') {echo 'selected="selected"';} ?>>NJ</option>
<option value="NM" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NM') {echo 'selected="selected"';} ?>>NM</option>
<option value="NY" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NY') {echo 'selected="selected"';} ?>>NY</option>
<option value="NC" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'NC') {echo 'selected="selected"';} ?>>NC</option>
<option value="ND" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'ND') {echo 'selected="selected"';} ?>>ND</option>
<option value="OH" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'OH') {echo 'selected="selected"';} ?>>OH</option>
<option value="OK" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'OK') {echo 'selected="selected"';} ?>>OK</option>
<option value="OR" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'OR') {echo 'selected="selected"';} ?>>OR</option>
<option value="PA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'PA') {echo 'selected="selected"';} ?>>PA</option>
<option value="RI" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'RI') {echo 'selected="selected"';} ?>>RI</option>
<option value="SC" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'SC') {echo 'selected="selected"';} ?>>SC</option>
<option value="SD" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'SD') {echo 'selected="selected"';} ?>>SD</option>
<option value="TN" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'TN') {echo 'selected="selected"';} ?>>TN</option>
<option value="TX" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'TX') {echo 'selected="selected"';} ?>>TX</option>
<option value="UT" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'UT') {echo 'selected="selected"';} ?>>UT</option>
<option value="VT" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'VT') {echo 'selected="selected"';} ?>>VT</option>
<option value="VA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'VA') {echo 'selected="selected"';} ?>>VA</option>
<option value="WA" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'WA') {echo 'selected="selected"';} ?>>WA</option>
<option value="WV" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'WV') {echo 'selected="selected"';} ?>>WV</option>
<option value="WI" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'WI') {echo 'selected="selected"';} ?>>WI</option>
<option value="WY" <?php if (isset($_POST['sub']) && $_POST['sub'] == 'WY') {echo 'selected="selected"';} ?>>WY</option>
</select>
</td>
</tr>
<tr>
<td colspan="4" align="center">
<script type="text/javascript" language="javascript">
<!--
onload = function() {
if(document.getElementById('check').value != '') {
setTimeout('clearForms()', 200);
}
}
-->
</script>
<center>
<input type="submit" name="Submit" class="submit" value="" onmouseover="this.style.backgroundPosition='bottom center'" onmouseout="this.style.backgroundPosition='top center'" />
</center>
</td>
</tr>
</table>
<div style="width:45%; float:left; text-align:left; margin-left:80px">
<h1 class="contact_header">Mailing Address</h1>
<p class="contact_text">1350 East Flamingo Rd, Ste 813<br />
Las Vegas, NV 89119<br />
(800) 848-9238<br />
(702) 977-1000[FAX]</p>
</div>
<div style="width:45%; float:left; text-align:left">
<h1 class="contact_header">Schedule a Speaker</h1>
<p class="contact_text">In order to set up a speaking engagement with an<br />
American Society for Asset Protection Speaker<br />
Please <a href="http://www.americansocietyap.org/schedule.php" target="_blank">Click Here</a></p>
</div>
</div>
<?php require_once('footer.php'); ?>