<?php
// Change these two variables to meet your needs.
$myemail = 'myemail@domain.com';
$subject = 'Contact form Subject';
$op = $_POST[op];
if($op == 'contact')
{
$name = stripslashes($_POST[name]);
$email = stripslashes($_POST[email]);
$text = stripslashes($_POST[text]);
$referer = $_POST[referer];
$remote_host = $_SERVER[REMOTE_ADDR];
$server = $_SERVER[SERVER_NAME];
$browser = $_SERVER[HTTP_USER_AGENT];
if(!eregi("^[_a-z0-9-]+(\.[_a-z0-9-]+)*@[a-z0-9-]+(\.[a-z0-9-]+)*(\.[a-z]{2,3})$",$email))
{
$status = "We're sorry, but you've entered an incorrect email address.<br>";
}
if(!$name)
{
$status .= "Please enter your name.<br>";
}
if(!$text)
{
$status .= "Please enter a message.<br>";
}
if(!$status)
{
$header = "From: $email\r\nReply-To: $email\r\n";
$message = "
Name: $name
Referer: $referer
Site: $server
Remote Host: $remote_host
Remote Browser: $browser
$text
";
if(mail($myemail, $subject, $message, $header))
{
$status = "Thank you for your Feedback!!<br><br>";
}
else
{
$status = "There was a problem sending your feedback, please try again later.<br><br>";
}
}
else
{
$status .= "<br>Please press <u>back</u> on your browser to resubmit.<br><br>";
}
}
// Now check the referer page and ensure it's a proper URL
$referer = $_SERVER[HTTP_REFERER];
if(!preg_match('#^http\\:\\/\\/[a-z0-9\-]+\.([a-z0-9\-]+\.)?[a-z]+#i', $referer))
{
unset($referer);
}
?>
<?php print $status; ?>
<form method="post" action="<?php print $_SELF; ?>">
<input type="hidden" name="op" value="contact">
<input type="hidden" name="referer" value="<?php print $referer; ?>">
Name<br><input name="name" size="35" value=""><br>
E-mail address<br><input name="email" size="35" value=""><br>
<br>Message<br><textarea name="text" cols="50" rows="10"></textarea><br><br>
<input type="submit" value="Send message!">
