/home/sprechma/public_html/form364924/tmp/persistent/form364924/processor.php


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<?php

$where_form_is
="http://".$_SERVER['SERVER_NAME'].strrev(strstr(strrev($_SERVER['PHP_SELF']),"/"));

session_start();
if( (
$_SESSION['security_code']==$_POST['security_code']) && (!empty($_POST['security_code'])) ) { 
// Checkbox handling
$field_15_opts $_POST['field_15'][0].","$_POST['field_15'][1].","$_POST['field_15'][2].","$_POST['field_15'][3];

// Checkbox handling
$field_16_opts $_POST['field_16'][0].","$_POST['field_16'][1].","$_POST['field_16'][2].","$_POST['field_16'][3];

// Checkbox handling
$field_17_opts $_POST['field_17'][0].","$_POST['field_17'][1].","$_POST['field_17'][2].","$_POST['field_17'][3].","$_POST['field_17'][4].","$_POST['field_17'][5].","$_POST['field_17'][6];

// File upload handling
if($_FILES['field_18']['name']!=''){
$field_18_filename "file_18_".date("sihdmY").substr($_FILES['field_18']['name'],strlen($_FILES['field_18']['name'])-4);
if(!
move_uploaded_file($_FILES['field_18']['tmp_name'], "./files/".$field_18_filename)){
die(
"File " .  $_FILES['field_18']['name'] . " was not uploaded.");
}
}

mail("newclaim@sprechmanlaw.com","phpFormGenerator - Form submission","Form data:

Debtor Name:: " 
$_POST['field_1'] . 
Contact:: " 
$_POST['field_2'] . 
Debtor Street Address:: " 
$_POST['field_3'] . 
Debtor City, State & Zip:: " 
$_POST['field_4'] . 
Debtor Home Phone #:: " 
$_POST['field_5'] . 
Debtor Social Security #:: " 
$_POST['field_6'] . 
Debtor Place of Employment:: " 
$_POST['field_7'] . 
Debtor Work Phone #:: " 
$_POST['field_8'] . 
Amount of Claim $:: " 
$_POST['field_9'] . 
Name of Debtors Bank:: " 
$_POST['field_10'] . 
Debtors Bank Account #:: " 
$_POST['field_11'] . 
Creditor Contact Name:: " 
$_POST['field_12'] . 
Title of Creditor Contact:: " 
$_POST['field_13'] . 
Organization:: " 
$_POST['field_14'] . 
Creditors Composition:: 
$field_15_opts
Basis of Claim: (Check all that apply): 
$field_16_opts
Upload Enclosures:: "
.$where_form_is."files/".$field_17_filename." (original file name: " $_FILES['field_17']['name'] . ")
Enclosures:: 
$field_18_opts
Remarks:: " 
$_POST['field_19'] . 
Forwarders Name:: " 
$_POST['field_20'] . 
Forwarders Title:: " 
$_POST['field_21'] . 
Forwarders Company Name:: " 
$_POST['field_22'] . 
Forwarders Street Address:: " 
$_POST['field_23'] . 
Forwarders City, State & Zip:: " 
$_POST['field_24'] . 
Forwarders Country:: " 
$_POST['field_25'] . 
Forwarders Fax #:: " 
$_POST['field_26'] . 
Forwarders Email Address:: " 
$_POST['field_27'] . 
Forwarders Website Address:: " 
$_POST['field_28'] . 
Forwarders Work Phone:: " 
$_POST['field_29'] . 


 powered by phpFormGenerator.
"
);

include(
"confirm.html");
}
else {
echo 
"Invalid Captcha String.";
}

?>