<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Test</title>
<style type="text/css">
<!--
body {
background-image: url();
background-color: #f4e2ba;
margin-left: 0px;
margin-right: 0px;
margin-top: 0px;
}
-->
</style>
<script type="text/javascript">
<!--
function MM_preloadImages() { //v3.0
var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array();
var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++)
if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}}
}
//-->
</script>
</head>
<body onload="MM_preloadImages('Untitled-1-2_r10_c6_f2.jpg','Untitled-1-2_r11_c2_f2.jpg')">
<table width="978" height="984" border="0" align="center">
<tr>
<td height="784" colspan="2" align="left"><?php
if ($_SERVER['REQUEST_METHOD'] == 'POST')
{
$date = date('d:m:Y');
$time = date('H:i');
$to = 'maakt@niet.uit';
$onderwerp = "RESERVEREN";
if(!empty($_POST['achternaam']) && !empty($_POST['adres']) && !empty($_POST['postcode']) && !empty($_POST['woonplaats']) && !empty($_POST['lijst']))
{
if( !eregi("[A-Za-z0-9_-]+([.]{1}[A-Za-z0-9_-]+)*@[A-Za-z0-9-]+([.]{1}[A-Za-z0-9-]+)+", $_POST['email']) )
{
unset($_POST['email']);
}
$headers = "From: ".( empty($_POST['email']) ? "contact@".$_SERVER['SERVER_NAME'] : $_POST['email'] )."\r\n" .
"Reply-To: ".( empty($_POST['email']) ? "contact@".$_SERVER['SERVER_NAME'] : $_POST['email'] )."\r\n" .
"X-Mailer: PHP/" . phpversion();
mail(
$to,
$onderwerp,
"Adres: ".$_POST['adres']."\n ".$_POST['postcode']." ".$_POST['woonplaats']."\nAantal personen: ".$_POST['lijst']."\nVerzonden op: ".$date." om ".$time."\n\n",
$headers
);
echo 'Uw bericht is succesvol verstuurd, klik op "Terug". <input type="BUTTON" value="Terug" onclick="history.back()" />';
}
else
{
echo 'Een of meerdere velden zijn niet of niet goed ingevuld, klik op "Terug". <input type="BUTTON" value="Terug" onclick="history.back()" />';
}
}
else
{
?>
<form action="<?=$_SERVER['PHP_SELF'];?>" method="post" name="form1" id="form1">
<table width="542" height="240" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td width="127" height="37" align="right" valign="middle">Achternaam:*</td>
<td width="299"><input name="achternaam" type="text" size="45" /></td>
</tr>
<tr>
<td height="37" align="right" valign="middle">Adres:*</td>
<td><input name="adres" type="text" size="45" /></td>
</tr>
<tr>
<td height="37" align="right" valign="middle">Postcode:*</td>
<td><input name="postcode" type="text" size="30" /></td>
</tr>
<tr>
<td height="37" align="right" valign="middle">Woonplaats:*</td>
<td><input name="woonplaats" type="text" size="45" /></td>
</tr>
<tr>
<td height="37" align="right" valign="middle" >Aantal personen:*</td>
<td><select name="lijst" id="lijst">
<option>1</option>
<option>2</option>
<option selected="selected">3</option>
</select>
</td>
<tr>
<td align="right" valign="top"></td>
<td>
<p>
<input type="submit" name="submit" value="Versturen" />
<input type="reset" name="Reset" value="Wissen" />
</p>
</td>
</tr>
</table>
</form>
<?php
}
?></td>
</tr>
</table>
</body>
</html>