CONTACT US You did not supply information in a required field (*)."; echo "Please complete the form below and click 'Send' when you are finished.\n"; if($uh == "on") { $uh=" checked='on'"; } if($mw == "on") { $mw =" checked='on'"; } if($ap == "on") { $ap=" checked='on'"; } if($gf == "on") { $gf=" checked='on'"; } } else { echo " If you would like to request information, please complete the form"; echo "below or use the contact information listed on the left. Your requests "; echo "and comments are important to us!\n"; } ?> Request Information Form Company: Your Name/Title: * Address: City, ST, Zip: * Phone: * E-mail: * Interests: name='uh' />U.H.T Cream name='mw' />Midwest Spray Drying Company name='ap'>Additional Products Comments: Please be as specific as possible when requesting information on products and services. <?php echo $comments; ?> request/comment form or contact us at: \n"; $m = date("m"); $d = date("d"); $y = date("Y"); $body = "Miller & Associates Information Request\n\n"; $body .= "The following information was submitted on $m/$d/$y:\n\n"; $body .= "Company:\n$company\n\nName:\n$name\n\nAddress:\n$address\n$city, $state $zip\n\n"; $body .= "Phone:\n$phone\n\nE-mail:\n$email\n\n"; $body .= "Interests:\n"; if($uh == "on") { $body .= " - U.H.T. Cream\n"; } if($gf == "on") { $body .= " - General Films\n"; } if($mw == "on") { $body .= " - Midwest Spray Drying Company\n"; } if($ap == "on") { $body .= " - Additional Products\n"; } $body .= "\nComments:\n$comments\n\n - - - End of Request - - -\n"; $recipient = "jmiller81@woh.rr.com"; $subject = "Miller & Associates Info. Request"; $mailheaders = ""; mail($recipient, $subject, $body, $mailheaders); ?> Miller & Associates 1662 W. Breese Rd. Unit 'G' Lima, Ohio 45806 Phone (419) 991-5000 Fax (419) 991-1662