<?
if (isset($_POST['subject']) && $_POST['message']!=='')
{
$address = "your_real_email@domain.com"; //change this to the receiving address.
$subject = "Website Email: ".$_POST['subject'];
if ($_POST['name']!=='')
{
$body = "<table border=0 cellpadding=5 cellspacing=0 width=200><tr><td>Birthday: "
.$_POST['birthday']." of ".$_POST['birthmonth']." ".$_POST['birthyear']."<br>Gender: ".
$_POST['gender']."<p>".$_POST['message']."<br>
<br>
Yours Sincerely<br>
".$_POST['name']."
<p>
Email: ".$_POST['email']."</td></tr></table>";
} else {
$body = "<table border=0 cellpadding=5 cellspacing=0 width=200><tr><td>Birthday: "
.$_POST['birthday']." of ".$_POST['birthmonth']." ".$_POST['birthyear']."<br>Gender: ".
$_POST['gender']."<p>".$_POST['message']."<p>Email: ".$_POST['email']."</td></tr></table>";
}
$headers = 'MIME-Version: 1.0' . "\r\n";
$headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n";
$headers .= 'From: do_not_reply@your_website_form' . "\r\n";
mail($address,$subject,$body,$headers);
}
//below displays the form while above processes it.
echo "<form method='post'><table border=0 cellpadding=0 cellspacing=0><tr><td>Subject:</td><td align=left colspan=1><input type=text value='' maxlength=100 name='subject' size=35></td></tr><tr><td>Email:</td><td align=left colspan=1><input type=text value='' name='email' size=35></td></tr><tr><td>Birthday:</td><td colspan=1 rowspan=2><table border=0 cellpadding=0 cellspacing=0><tr><td colspan=2><select name='birthday' size=1>
<option value='1'>1</option>
<option value='2'>2</option>
<option value='3'>3</option>
<option value='4'>4</option>
<option value='5'>5</option>
<option value='6'>6</option>
<option value='7'>7</option>
<option value='8'>8</option>
<option value='9'>9</option>
<option value='10'>10</option>
<option value='11'>11</option>
<option value='12'>12</option>
<option value='13'>13</option>
<option value='14'>14</option>
<option value='15'>15</option>
<option value='16'>16</option>
<option value='17'>17</option>
<option value='18'>18</option>
<option value='19'>19</option>
<option value='20'>20</option>
<option value='21'>21</option>
<option value='22'>22</option>
<option value='23'>23</option>
<option value='24'>24</option>
<option value='25'>25</option>
<option value='26'>26</option>
<option value='27'>27</option>
<option value='28'>28</option>
<option value='29'>29</option>
<option value='30'>30</option>
<option value='31'>31</option>
</select><select name='birthmonth' size=1>
<option value='January'>Jan</option>
<option value='February'>Feb</option>
<option value='March'>Mar</option>
<option value='April'>Apr</option>
<option value='May'>May</option>
<option value='June'>Jun</option>
<option value='July'>Jul</option>
<option value='August'>Aug</option>
<option value='September'>Sep</option>
<option value='October'>Oct</option>
<option value='November'>Nov</option>
<option value='December'>Dec</option>
</select><input size=7 maxlength=4 name='birthyear'></td></tr><tr><td> Male:<input type='radio' name='gender' value='Male'></td><td align='right'>Female:<input type='radio' name='gender' value='Female'></td></tr></table></td></tr><tr><td>Gender:</td></tr><tr><td colspan=3><textarea cols=35 rows=20 name='message'></textarea><br>Name: <input type='text' value='' name='name' size=28><input type='submit' value='submit'></td></tr></table></form>";
?>