Contact Us

All fields are required. Please check your information and try again.

'; $display .= '

Go back

'; } else{ $name = $_POST['name']; $company = $_POST['company']; $email = $_POST['email']; $phone = $_POST['phone']; $address = $_POST['address']; $conemail = $_POST['conemail']; $conphone = $_POST['conphone']; $calltime = $_POST['calltime']; $faccom = $_POST['faccom']; $facres = $_POST['facres']; $comments = $_POST['comments']; // send form results through email $recipient = "jimw@stormprotx.com"; $subject = "Request from website"; $forminfo = ( "Name: " . $name . "\r" . "Company: " . $company . "\r" . "Email: " . $email . "\r" . "Phone: " . $phone . "\r" . "Address: " . $address . "\r" . "Preferred Contact: " . $conemail . "\r" . $conphone . "\r" . "Best time to call: " . $calltime . "\r" . "Facility Type: " . $faccom . "\r" . $facres . "\r" . "Needs: " . $comments . "\r\n" . date("M-d-Y") . "\r\n\n" ); $formsend = mail("$recipient", "$subject", "$forminfo", "From: $email\r\nReply-to:$email\r\n"); $display .= '

Thank you. You have successfully submitted the following information:

'; $display .= nl2br($forminfo); } ?>