0) { $function_ret=""; } } return $function_ret; } function MyEmpty($instring) { extract($GLOBALS); if ($_POST[$instring]=='' || strlen(trim($_POST[$instring]))==0) { $function_ret=true; } else { $function_ret=false; } return $function_ret; } function CheckTheForm() { extract($GLOBALS); if (MyEmpty("hearaboutus")) { $GlobalMsg="Please tell us how you heard about us."; $FailedFields=$FailedFields."hearaboutus,"; $IsPageGood=false; } if (MyEmpty("email")) { $GlobalMsg="Please enter your Email address."; $FailedFields=$FailedFields."email,"; $IsPageGood=false; } if (MyEmpty("phone")) { $GlobalMsg="Please enter your phone number."; $FailedFields=$FailedFields."phone,"; $IsPageGood=false; } if (MyEmpty("zip")) { $GlobalMsg="Please enter your zip code."; $FailedFields=$FailedFields."zip,"; $IsPageGood=false; } if (MyEmpty("state")) { $GlobalMsg="Please enter your state."; $FailedFields=$FailedFields."state,"; $IsPageGood=false; } if (MyEmpty("city")) { $GlobalMsg="Please enter your city."; $FailedFields=$FailedFields."city,"; $IsPageGood=false; } if (MyEmpty("address1")) { $GlobalMsg="Please enter your address."; $FailedFields=$FailedFields."address1,"; $IsPageGood=false; } if (MyEmpty("centername")) { $GlobalMsg="Please enter the name of your center."; $FailedFields=$FailedFields."centername,"; $IsPageGood=false; } if (MyEmpty("lastname")) { $GlobalMsg="Please enter your last name."; $FailedFields=$FailedFields."lastname,"; $IsPageGood=false; } if (MyEmpty("firstname")) { $GlobalMsg="Please enter your first name."; $FailedFields=$FailedFields."firstname,"; $IsPageGood=false; } if (strlen($hidden_field)>0) { if (strtoupper($hidden_field)==strtoupper($_SESSION['CAPTCHA'])) { $GlobalMsg="Verified OK"; } else { $GlobalMsg="Please enter the correct characters for the validation field."; $IsPageGood=false; } } else { $IsPageGood=false; $GlobalMsg="Please be sure to answer the verification question!"; } if ($IsPageGood==true) { Send_Email(); } return $function_ret; } //----- This is for submitting request to a database table. This has been temporarily replaced with the send email function below! ------ /* function Submit_to_DB() { } */ function Send_Email() { extract($GLOBALS); $msg=("This daycare center is requesting more information!:"."\r\n"."\r\n". $centername."\r\n"."\r\n". "Name: ".$firstname." ".$lastname."\r\n"."\r\n". "Address: ".$address1."\r\n". "City, State, Zip: ".$city.", ".$state." ".$zip."\r\n"."\r\n". "Phone Number: ".$phone."\r\n"."\r\n". "Email: ".$email."\r\n"."\r\n". "Number of cameras:".$cameras."\r\n". "Heard About Us: ".$centername."\r\n"."\r\n". "Additional Commetns: "."\r\n".$comments."\r\n"."\r\n". "Please get in contact with them."); // $mail is of type "Persits.MailSender" $mail->Host="mail.nutech.com"; $mail->From="postmaster@nutech.com"; $mail->FromName=$firstname." ".$lastname; //mail.AddAddress("scott@nutech.com") //mail.AddAddress("center-request@parent-view.com") $mail->AddAddress("sales@nutech.com"); $mail->AddBCC("mathewss@corp.nutech.com"); $mail->isHtml=$isHtml; $mail->Subject="Child Care Center Request Form"; $mail->Body=$msg; $mail->Send(); $mail=null; header("Location: "."thankyou.php"); return $function_ret; } ?> Parent-View.com - safe webcam viewing systems for daycare
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CENTER REQUEST FORM

Thanks for your interest in the Parent View Online Viewing System. Please fill out the following request form and one of our specialists will contact you with in 24 hours. Or call our office to speak with one of our specialists.

TITLE

Mr. Mrs. Ms. Dr.

FIRST NAME

LAST NAME

CENTER NAME

 ADDRESS 1

 ADDRESS 2

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STATE

ZIP

PHONE

EMAIL

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CAMERAS ARE YOU
INTERESTED IN?

NOTE: we can help you determine the number of cameras necessary for your facility.

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