Topic: need help
can ome one help me with this i abuild a page were i need to gather information but i dont know how to build the databass please help if can
<?include "header.php";?>
<style type="text/css">
<!--
.style1 {font-size: medium}<?include "header.php";?>
<style type="text/css">
<!--
.style1 {font-size: medium}
.style2 {font-size: large}
body {
background-image: url(../../moverscommunity.com/Templates/pages/bg_paper.gif);
}
-->
</style>
<body tracingsrc="../../moverscommunity.com/Templates/pages/bg_paper.gif" tracingopacity="100"><table width=683 cellpadding=0 cellspacing=10><tr>
<td><div align="center">Requesting a Free Estimate for Household Move:<br />
<br />
The information you provide below will be forwarded to qualified movers in your area who will contact you for free moving estimates.<br />
<br />
<U>Note</U>: The information collected from this form is for internal use only. Your information will not be sold or distributed to anyone except qualified movers in your area<span class="style1">. </span></div></td>
<td rowspan=3 style='background:#dddddd;font-size:1px;width:1px' width=1> </td>
<tr valign=top><td><center>
<h1 class="style1">Complete the form below and receive up to 10 quotes <br />
from insured and license movers in your area. </h1>
</center>
<form action="file:///C|/Documents and Settings/avidan/My Documents/pages2/moving_quote_optional_step1.php" method="post" name="qtfrm" id="qtfrm" onSubmit="return chkSubmit(2)">
<table width="85%" align="center">
<tbody>
<tr>
<td><table cellspacing="0" cellpadding="0" align="center">
<tbody>
<tr>
<td align="middle" colspan="2"><h2>Personal Information</h2></td>
</tr>
<tr>
<td bgcolor="#336699" colspan="2" height="2"></td>
</tr>
<tr>
<td colspan="2" height="4"></td>
</tr>
<tr>
<td>First Name: </td>
<td><input tabindex="1" size="25" name="First_Name" />
*</td>
</tr>
<tr>
<td>Last name: </td>
<td><input tabindex="2" size="25" name="Last_Name" />
*</td>
</tr>
<tr>
<td>Home Phone: </td>
<td><input onKeyUp="Javascript:PhoneValidate(this,'Hphone2',3);" tabindex="3" maxlength="3" name="Hphone1" />
-
<input onKeyUp="Javascript:PhoneValidate(this,'Hphone3',3);" tabindex="4" maxlength="3" name="Hphone2" />
-
<input onKeyUp="Javascript:PhoneValidate(this,'Hphoneext',4);" tabindex="5" maxlength="4" name="Hphone3" />
-(ext.)
<input tabindex="6" maxlength="4" name="Hphoneext" />
*</td>
</tr>
<tr>
<td>Work Phone: </td>
<td><input onKeyUp="Javascript:PhoneValidate(this,'Wphone2',3);" tabindex="7" maxlength="3" name="Wphone1" />
-
<input onKeyUp="Javascript:PhoneValidate(this,'Wphone3',3);" tabindex="8" maxlength="3" name="Wphone2" />
-
<input onKeyUp="Javascript:PhoneValidate(this,'Wphoneext',4);" tabindex="9" maxlength="4" name="Wphone3" />
-(ext.)
<input tabindex="10" maxlength="4" name="Wphoneext" /></td>
</tr>
<tr>
<td>Email: </td>
<td><input tabindex="11" size="25" name="Email" />
*</td>
</tr>
<tr>
<td>Contact me at: </td>
<td><select tabindex="12" name="Contact_Preference">
<option value="" selected="selected">Select Phone</option>
<option value="home">Home</option>
<option value="work">Work</option>
</select>
* in the
<select tabindex="13" name="Contact_Time">
<option value="" selected="selected">Select Time</option>
<option value="morning">Morning</option>
<option value="noon">Noon</option>
<option value="evening">Evening</option>
<option value="anytime">AnyTime</option>
</select>
*</td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="0" align="center">
<tbody>
<tr>
<td align="middle" colspan="4"> </td>
</tr>
<tr>
<td align="middle" colspan="4"><h2>Moving Information</h2></td>
</tr>
<tr>
<td bgcolor="#336699" colspan="4" height="2"></td>
</tr>
<tr>
<td colspan="4" height="4"></td>
</tr>
<tr>
<td> </td>
<td>Moving From</td>
<td> </td>
<td>Moving To</td>
</tr>
<tr>
<td>City: </td>
<td><input tabindex="14" size="15" value="New York" name="From_City" />
*</td>
<td>City: </td>
<td><input tabindex="17" size="15" name="To_City" /></td>
</tr>
<tr>
<td>State: </td>
<td><select tabindex="15" name="From_State">
<option value="">Select State</option>
<option value="Alaska">Alaska</option>
<option value="Alabama">Alabama</option>
<option value="American Samoa">American Samoa</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Guam">Guam</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York" selected="selected">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Palau">Palau</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Armed Forces Middle East">Armed Forces Middle East</option>
<option value="Armed Forces Americas (except Canada)">Armed Forces Americas (except Canada)</option>
<option value="Armed Forces Pacific">Armed Forces Pacific</option>
</select>
*</td>
<td>State: </td>
<td><select tabindex="18" name="To_State">
<option value="">Select State</option>
<option value="Alaska">Alaska</option>
<option value="Alabama">Alabama</option>
<option value="American Samoa">American Samoa</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Federated States of Micronesia">Federated States of Micronesia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Guam">Guam</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan" selected="selected">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Palau">Palau</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Armed Forces Middle East">Armed Forces Middle East</option>
<option value="Armed Forces Americas (except Canada)">Armed Forces Americas (except Canada)</option>
<option value="Armed Forces Pacific">Armed Forces Pacific</option>
</select>
*</td>
</tr>
<tr>
<td>Zip: </td>
<td><input tabindex="16" maxlength="5" size="5" value="10005" name="From_Zip" />
*</td>
<td>Zip: </td>
<td><input tabindex="19" maxlength="5" size="5" name="To_Zip" />
*</td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="0" align="center">
<tbody>
<tr>
<td align="middle" colspan="2"> </td>
</tr>
<tr>
<td align="middle" colspan="2"><h2>Additional Information</h2></td>
</tr>
<tr>
<td bgcolor="#336699" colspan="2" height="2"></td>
</tr>
<tr>
<td colspan="2" height="4"></td>
</tr>
<tr>
<td height="25">Move Date: </td>
<td><select tabindex="20" size="1" name="MoveMonth">
<option value="1">Jan</option>
<option value="2">Feb</option>
<option value="3">Mar</option>
<option value="4">Apr</option>
<option value="5">May</option>
<option value="6">Jun</option>
<option value="7">Jul</option>
<option value="8">Aug</option>
<option value="9" selected="selected">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dec</option>
</select>
<select tabindex="21" size="1" name="MoveDay">
<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" selected="selected">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 tabindex="22" size="1" name="MoveYear">
<option value="2009" selected="selected">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
</select>
*</td>
</tr>
<tr>
<td height="25">Move Size: </td>
<td><select tabindex="23" size="1" name="Move_Size">
<option value="">Residential Types:</option>
<option value="Partial Home">Partial Home</option>
<option value="Studio">Studio</option>
<option value="1 Small Bedroom">1 Small Bedroom</option>
<option value="1 Large Bedroom">1 Large Bedroom</option>
<option value="2 Bedroom">2 Bedroom</option>
<option value="3 Bedroom" selected="selected">3 Bedroom</option>
<option value="4 Bedroom">4 Bedroom</option>
<option value="More Than 4 Bedroom">More Than 4 Bedroom</option>
</select>
*</td>
</tr>
<tr>
<td height="25">Comments: </td>
<td><textarea tabindex="24" name="Comments" rows="4" cols="40"></textarea></td>
</tr>
<tr>
</tr>
<tr>
<td colspan="2"><br />
<input name="submit" type="submit" tabindex="30" value="Submit" /></td></tr>
<tr>
</tbody>
</table></td>
</tr>
</tbody>
</table>
<input name="hidden" type="hidden" id="areacode" value="201|202|203|204|205|206|207|208|209|210|211|212|213|214|215|216|217|218|219|224|225|226|228|229|231|234|236|239|240|242|246|248|250|251|252|253|254|256|260|262|264|267|268|269|270|276|278|281|283|284|289|301|302|303|304|305|306|307|308|309|310|311|312|313|314|315|316|317|318|319|320|321|323|325|330|331|334|336|337|339|340|341|345|347|351|352|360|361|369|380|385|386|401|402|403|404|405|406|407|408|409|410|411|412|413|414|415|416|417|418|419|423|424|425|430|432|434|435|438|440|441|442|443|450|456|464|469|470|473|475|478|479|480|484|500|501|502|503|504|505|506|507|508|509|510|511|512|513|514|515|516|517|518|519|520|530|540|541|551|555|557|559|561|562|563|564|567|570|571|573|574|575|580|585|586|600|601|602|603|604|605|606|607|608|609|610|611|612|613|614|615|616|617|618|619|620|623|626|627|628|630|631|636|641|646|647|649|650|651|660|661|662|664|669|670|671|678|679|682|684|689|700|701|702|703|704|705|706|707|708|709|710|711|712|713|714|715|716|717|718|719|720|724|727|731|732|734|737|740|747|754|757|758|760|762|763|764|765|767|769|770|772|773|774|775|778|779|780|781|784|785|786|787|800|801|802|803|804|805|806|807|808|809|810|811|812|813|814|815|816|817|818|819|822|828|829|830|831|832|833|835|843|844|845|847|848|850|855|856|857|858|859|860|862|863|864|865|866|867|868|869|870|872|876|877|878|880|881|882|888|898|900|901|902|903|904|905|906|907|908|909|910|911|912|913|914|915|916|917|918|919|920|925|927|928|931|935|936|937|939|940|941|947|949|951|952|954|956|957|959|970|971|972|973|975|976|978|979|980|984|985|989" />
</form></td>
<tr>
<td><a href="movingtips" class="style2">Moving Tips Must Read </a></td>
</table>
<p>
<?include "footer.php";?>
