php kasko teklif formu lütfen yardım

<td height="29"><span class="style14"><font size="1">
<select name="aksesuar" size="1" id="aksesuar" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000">
<option>Lütfen Seçim Yapınız..</option>
<option>Var</option>
<option>Yok</option>
<option>DOKTOR</option>
</select>
* </font></span></td>
</tr>
<tr>
<td align="right" vAlign="middle" height="29"><span class="style11">EKSTRA AKSESUARLAR : </span></td>
<td height="29"><span class="style14"><font size="1">
<textarea name="aksesuardetay" cols="49" rows="5" id="aksesuardetay" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000">Lütfen Bu bölüme aracinizi aldiktan sonraki bütün aksesuarlari fiyatlariyla birlikte giriniz.</textarea>
* </font></span></td>
</tr>
<tr>
<td height="75" colspan="2">
<p align="center"> <font size="1"><span class="style14"></span></font><font size="1" color="#FFD700">
<input type="submit" value=" Gönder " style="font-weight: italic; border: 1px solid #FFD700; padding: 0; background-color: #000000; color:#FFD700">

<input type="reset" value=" Sil " style="font-weight: italic; border: 1px solid #FFD700; padding: 0; background-color: #000000; color:#FFD700">
</font></p>
<p align="center" class="style2 style13">
<font color="#FFFFFF">* İşaretli Alanların Doldurulması Zorunludur... <br>
</font></td>
<p align="center">
<font face="verdana" size="1" color="#FFFFFF"> </font><td width="12"></td>
</tr>
</table>
</center>
</div>
</form>
</body>

</html>

gonder php

<? 
   
  $alici = "buraya mail adresi geliyor";  
  $konu = "is basvurusu"; / 
  $mesaj = "Gerekli bilgiler asagida bulunmaktadir  
   
   
   
  -----------------TEKLIF AKMAK ISTEYEN MÜSTERININ BILGILERI ASAGIDADIR------------------- 
   
   
   
  Ruhsat Sahibi :$ruhsatsahibi 
   
  Kullanim Tarzi: $kullanimtarzi 
   
  Aracin Markasi: $aracmarka 
   
  Araç Model Yili: $aracmodelyili 
   
  Ruhsat Tescil Tarihi: $ruhsattesciltarihi 
   
  Arac Tipi: $aractipi 
   
  Arac Plakasi: $aracplaka 
   
  Ikamet Ettigi il: $ikametil 
   
  Police varmi ?: $police 
   
  Yürürlükte olan Poliçe Sirketi: $policesirketi 
   
  Poliçenin Bitis Tarihi: $policebitistarihi 
   
  Poliçe Numarasi: $policenumarasi 
   
  Poliçe Acente Numarasi: $policeacenteno 
   
  Hasar Tazminati Almismi ?: $hasartazminati 
   
  Hasar Tazminati Almismi ?: $hasartazminati 
   
  Hasarsizlik Indirimi : $hasarsizlikindirimi 
   
  RUHSAT SAHIBI BILGILERI 
   
  Cinsiyet: $cinsiyet 
   
  Dogum Tarihi: $dogumtarihi 
   
  Ehliyet Verilis Tarihi: $ehliyetverilis 
   
  TC KIMLIK NUMARASI: $tckimlikno 
   
  --INDIRIMLER-- 
   
  MESLEK INDIRIMI: $meslek 
   
  KURUM INDIRIMI: $kurum 
   
  --AKSESUAR BILGILERI-- 
   
  ARAC DA AKSESUAR VARMI ?: $aksesuar 
   
  Araçta Bulunan Aksesuarlar: $aksesuardetay 
   
  Talep ettigi aylik ucret: $aylik 
   
  -------FORM BURADA SONA ERMiStiR!---------- 
   
  "; // size gönderilecek olan postanin içerik bölümü 
  mail($alici, $konu, $mesaj, "From: $ad <$eposta>\nX-Mailer: PHP/" . phpversion()); 
  header( "Content-Type: text/html; charset=iso-8859-1\n" );  
  header("Location: gonderildi.php"); 
  ?>

gonderildi php

<!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=iso-8859-1" /> 
  <title>İş Başvuru Formu</title> 
  <style type="text/css"> 
  <!-- 
  .style1 { 
  	color: #FFFFFF; 
  	font-weight: bold; 
  } 
  --> 
  </style> 
  </head> 
   
  <body bgcolor="#666666"> 
  <div align="center"> 
    <p> </p> 
    <p class="style1">Mesajınız Başarıyla Gönderilmiştir. Teşekkür ederiz .</p> 
    <p>  </p> 
  </div> 
  </body> 
  </html>

Selamlar. Bir sigortacı sitesi yapıyorum. Sİtede online kasko teklif formları hazırladım ama formalar da boş alan kalınca hata vermesi gerekiyor. Birtürlü yapamadım. Kodları aşağıda verdim. Mesela arac marka kısmı boş kaldığında hata vermesi lazım. Yardımlarınızı bekliyorum. şimdiden teşekkürler.

index php

 
  <html> 
   
  <head> 
   
  <title>BASVURU FORMU</title> 
   
   
  <style type="text/css"> 
  <!-- 
  .unnamed1 { 
  } 
  .style2 {font-family: Verdana, Arial, Helvetica, sans-serif} 
  .style7 { 
  	font-size: 10px; 
  	font-weight: bold; 
  	color: #FFFFFF; 
  } 
  .style11 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; color: #FFFFFF; font-weight: bold; } 
  body,td,th { 
  	color: #FFFFFF; 
  } 
  .style12 { 
  	color: #FFFFFF; 
  	font-weight: bold; 
  } 
  .style13 {font-size: 10px} 
  .style14 {color: #FFFFFF} 
  body { 
  	background-color: #333333; 
  } 
  .style15 {color: #FFCC00} 
  --> 
  </style> 
  </head> 
   
  <script language="javascript"> 
  function validate() 
  { 
   
  		if ($aracmarka.value == "") 
  			{ 
  			alert("Lütfen Ad ve Soyad bölümünü doldurun !") 
  			document.form.aracmarka.select(); 
  			document.form.aracmarka.focus(); 
  			return false; 
  			} 
   
  		if (document.form.evtel.value == "") 
  			{ 
  			alert("Lütfen Ev Telefonu bölümünü doldurun !") 
  			document.form.evtel.select(); 
  			document.form.evtel.focus(); 
  			return false; 
  			} 
   
  return true; 
  } 
  </script> 
   
  <body link="#FFD700" vlink="#FFD700" alink="#FFD700" leftmargin="0" topmargin="0"> 
  <center> 
    <p> </p> 
    <p><strong>n&n SİGORTA MİLAS - SİGORTA TEKLİF FORMU </strong></p> 
  </center> 
   
   
                 
   
  <form method="post" action="gonder.php"> 
                  <div align="center"> 
                    <center> 
                    <table border="0" cellPadding="0" cellSpacing="1" height="760"> 
                      <tr> 
                        <td width="260" colspan="2" align="right">                      </td> 
                      </tr> 
                      <tr> 
                        <td height="1" align="right"><span class="style11">RUHSAT SAHİBİ: </span></td> 
                        <td height="1"><span class="style12"> 
                        <font size="1"> 
                          <select name="ruhsatsahibi" size="1" id="ruhsatsahibi" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option>Lütfen Seçim Yapınız</option> 
                            <option>Kişi</option> 
                            <option>Firma</option> 
                                                  </select> 
                        </font> *                      </span></td> 
                      </tr> 
                      <tr> 
                        <td height="2" align="right"><span class="style11">KULLANIM TARZI  :</span></td> 
                        <td height="2"><span class="style12"> 
                        <font size="1"> 
                          <select name="kullanimtarzi" size="1" id="kullanimtarzi" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option>Lütfen Seçim Yapınız</option> 
                            <option>Hususi</option> 
                            <option>Kamyonet</option> 
                            <option>Van</option> 
                                                  </select> 
                        </font> *                      </span></td> 
                      </tr> 
                      <tr> 
                        <td height="5" align="right"><span class="style11">ARACINIZIN MARKASINI GİRİNİZ  : </span></td> 
                        <td height="5"><span class="style12"> 
                          <input name="aracmarka" id="aracmarka" style="font-family: verdana; color: #FFD700; font-size: 8pt; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" size="30"> 
  *                      </span></td> 
                      </tr> 
                      <tr> 
                        <td height="10" align="right"><span class="style11">ARACINIZIN MODEL YILI  :</span></td> 
                        <td height="10"><span class="style12"> 
                          <input name="aracmodelyili" id="aracmodelyili" style="font-family: verdana; color: #FFD700; font-size: 8pt; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" size="30"> 
  *                      </span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">RUHSAT TESCİL TARİHİ  :</span></td> 
                        <td height="21"><span class="style12"> 
                          <input name="ruhsattesciltarihi" type="text" id="ruhsattesciltarihi" style="font-family: verdana; color: #FFD700; font-size: 8pt; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="...../...../......." size="30"> 
  *</span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">ARACINIZIN TİPİNİ GİRİNİZ  : </span></td> 
                        <td height="21"><span class="style12"><font size="1"> 
                          <textarea name="aractipi" cols="49" rows="4" id="aractipi" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000">Bu bölümde aracinizin özelliklerini eksiksiz olarak yaziniz. 
  Örnek; Tofas Linea 1.4 Active</textarea> 
                          * 
                        </font></span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">ARACINIZIN PLAKASINI GİRİNİZ: </span></td> 
                        <td height="21"><span class="style12"><font size="1"> 
                          <input name="aracplaka" id="aracplaka" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Plakanız belli değilse geçici plaka giriniz." size="30"> 
  *                      </font></span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">İKAMET ETTİĞİNİZ İLİ GİRİNİZ: </span></td> 
                        <td height="21"><span class="style12"><font size="1"> 
                          <input name="ikametil" id="ikametil" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" size="30"> 
  *                      </font></span></td> 
                      </tr> 
  					<td height="20" colspan="2" align="right" vAlign="middle"><div align="center" class="style11"> 
                        --YÜRÜRLÜKTE OLAN POLİÇE BİLGİLERİNİZ-- </div></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">ARACINIZA AİT POLİÇENİZ VARMI ?: </span></td> 
                        <td height="21"><span class="style14"><font size="1"> 
                          <select name="police" size="1" id="police" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option>Lütfen Seçim Yapınız</option> 
                            <option>VAR</option> 
                            <option>YOK</option> 
                          </select> 
  *                      </font> 
                        </span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">POLİÇE ALDIĞINIZ SİGORTA ŞİRKETİ: </span></td> 
                        <td height="21"><span class="style14"> 
                        <font size="1"> 
  <select name="policesirketi" size="1" id="policesirketi" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
    <option>Lütfen Seçim Yapınız</option> 
    <option>AIG SİGORTA A.Ş</option> 
    <option>AK SİGORTA A.Ş</option> 
    <option>AKDENİZ SİGORTA A.Ş</option> 
    <option>ANADOLU SİGORTA A.Ş</option> 
    <option>ANKARA SİGORTA A.Ş</option> 
    <option>AVİVA SİGORTA A.Ş</option> 
    <option>AXA SİGORTA A.Ş</option> 
    <option>BAŞAK SİGORTA A.Ş</option> 
    <option>BATI SİGORTA A.Ş</option> 
    <option>BİRLİK SİGORTA A.Ş</option> 
    <option>DEMİR SİGORTA A.Ş</option> 
    <option>EGE SİGORTA A.Ş</option> 
    <option>EGS SİGORTA A.Ş</option> 
    <option>ERGO İSVİÇRE SİGORTA A.Ş</option> 
    <option>EUREKO SİGORTA A.Ş</option> 
    <option>FİBA SİGORTA A.Ş</option> 
    <option>GENERALİ KENT SİGORTA A.Ş</option> 
    <option>GÜNEŞ SİGORTA A.Ş</option> 
    <option>GÜVEN SİGORTA A.Ş</option> 
    <option>HDI SİGORTA A.Ş</option> 
    <option>HÜR SİGORTA A.Ş</option> 
    <option>IŞIK SİGORTA A.Ş</option> 
    <option>KAPİTAL SİGORTA A.Ş</option> 
    <option>KOÇ ALLIANZ SİGORTA A.Ş</option> 
    <option>LİBERTY SİGORTA A.Ş</option> 
    <option>MAGDEBURGER SİGORTA A.Ş</option> 
    <option>MERKEZ SİGORTA A.Ş</option> 
    <option>RAY SİGORTA A.Ş</option> 
    <option>SANKO SİGORTA A.Ş</option> 
    <option>T.GENEL SİGORTA A.Ş</option> 
    <option>TİCARET SİGORTA A.Ş</option> 
    <option>TOPRAK SİGORTA A.Ş</option> 
    <option>TÜRK NİPPON SİGORTA A.Ş</option> 
    <option>UNİVERSAL SİGORTA A.Ş</option> 
    <option>YAPI KREDİ SİGORTA A.Ş</option> 
    <option>ZURİCH SİGORTA A.Ş</option> 
  </select>  
  *                      </font> </span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">POLİÇENİZİN BİTİŞ TARİHİ  :</span></td> 
                        <td height="21"><span class="style14"> 
                        <font size="1"> 
  <input name="policebitistarihi" id="policebitistarihi" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Lütfen Tarih giriniz" size="30">  
  *                      </font> </span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">POLİÇE NUMARASI : </span></td> 
                        <td height="21"><span class="style14"><font size="1"> 
                        <span class="style12"> 
                          <input name="policenumarasi" class="style14" id="policenumarasi" style="font-family: verdana; color: #FFD700; font-size: 8pt; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Poliçe Numaranız" size="30"> 
                        </span> *                      </font> 
                        </span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><span class="style11">POLİÇENİN ACENTE NUMARASI : </span></td> 
                        <td height="21"><span class="style14"><font size="1"> 
                        <span class="style12"> 
                          <input name="policeacenteno" id="policeacenteno" style="font-family: verdana; color: #FFD700; font-size: 8pt; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Acente Numaranız" size="30"> 
                        </span> *                      </font> 
                        </span></td> 
                      </tr> 
                      <tr> 
                        <td align="right" height="32"><span class="style11"> 
                        POLİÇENİZDEN HASAR TAZMİNATI ALDINIZMI:</span></td> 
                        <td height="32"><span class="style14"><font size="1"> 
                        <select name="hasartazminati" size="1" id="hasartazminati" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                          <option>Lütfen Seçim Yapınız</option> 
                          <option>Evet</option> 
                          <option>Hayır</option> 
                                                                    </select> 
                        *</font></span></td> 
                      </tr> 
                      <tr> 
                        <td align="right" height="21"><span class="style11"> 
                        HASARSIZLIK İNDİRİMİ :</span></td> 
                        <td height="21"><span class="style14"><font size="1"> 
                        <select name="hasarsizlikindirim" size="1" id="hasarsizlikindirimi" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                          <option>Mutlaka Seçim Yapınız.</option> 
                          <option>1.Yıl</option> 
                          <option>2.Yıl</option> 
                          <option>3.Yıl</option> 
                          <option>4.Yıl</option> 
                          <option>5.Yıl</option> 
                          <option>6.Yıl</option> 
                          <option>7.Yıl</option> 
                          <option>8.Yıl</option> 
                          <option>9.Yıl</option> 
                          <option>10.Yıl</option> 
                                                                    </select> 
                        *</font></span></td> 
                      </tr><td height="20" colspan="2" align="right" vAlign="middle"><div align="center" class="style11">-- 
                        RUHSAT SAHİBİ BİLGİLERİ-- </div></td> 
                      </tr> 
                      <tr> 
                        <td align="right" height="21"><span class="style11"> 
                        CİNSİYET :</span></td> 
                        <td height="21"><span class="style14"><font size="1"> 
                          <select name="cinsiyet" size="1" id="cinsiyet" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option>Lütfen Seçim Yapınız</option> 
                            <option>BAY</option> 
                            <option>BAYAN</option> 
                          </select> 
  *                      </font> 
                        </span></td> 
                      </tr> 
                      <tr> 
                        <td height="10" align="right"><span class="style11"> 
                        DOĞUM TARİHİ :</span></td> 
                        <td height="10"> 
                          <span class="style14"><font size="1"> 
                          <input name="dogumtarihi" id="dogumtarihi" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Lütfen Tarih giriniz.." size="30"> 
  *                      </font> </span></td> 
                      </tr> 
                      <tr> 
                        <td height="10" align="right"><span class="style11">EHLİYET VERİLİŞ YILI  : </span></td> 
                        <td height="10"><span class="style14"><font size="1"> 
                          <input name="ehliyetverilis" id="ehliyetverilis" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" value="Sadece Yıl Giriniz.." size="30"> 
  *                      </font></span></td> 
                      </tr> 
                      <tr> 
                        <td height="21" align="right"><p class="style2 style7">TC KİMLİK NUMARASI  :</p>                      </td> 
                        <td height="21"><span class="style14"><font size="1"> 
                          <input name="tckimlikno" id="tckimlikno" style="color: #FFD700; font-weight: italic; border: 1px solid #FFD700; background-color: #000000" size="30" maxlength="11"> 
  *                      </font></span></td> 
                      </tr> 
                      <tr>                    </tr> 
                      <tr> 
                        <td height="20" colspan="2" align="right" vAlign="middle"><div align="center" class="style11">-- 
                        İNDİRİMLER--</div></td> 
                      </tr> 
                      <tr> 
                        <td align="right" vAlign="middle" height="28"><span class="style11">MESLEK İNDİRİMİ  : </span></td> 
                        <td height="28"><font size="1"> 
                          <select name="meslek" size="1" id="meslek" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option selected>Lütfen Meslek Seçiniz..</option> 
                            <option>ANANİM ŞİRKETİ ÇALIŞANI</option> 
                            <option>AVUKAT</option> 
                            <option>DEVLET MEMURU</option> 
                            <option>DİŞ HEKİMİ</option> 
                            <option>DOKTOR</option> 
                            <option>ECZACI</option> 
                            <option>MALİ MÜŞAVİR</option> 
                            <option>MİMAR</option> 
                            <option>MÜHENDİS</option> 
                            <option>ÖĞRETİM ÜYESİ</option> 
                            <option>ÖĞRETMEN</option> 
                            <option>TSK ASTSUBAY</option> 
                            <option>TSK SUBAY</option> 
                                                  </select> 
                        </font></td> 
                      </tr> 
                      <tr> 
                        <td align="right" vAlign="middle" height="14"><span class="style11">KURUM İNDİRİMİ  : </span></td> 
                        <td height="14"><font size="1"> 
                          <select name="kurum" size="1" id="kurum" style="color: #FFD700; border: 1px solid #FFD700; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1; background-color: #000000"> 
                            <option>Lütfen Kurum Seçiniz</option> 
                            <option>Aliağa/Petkim Çalışanları</option> 
                            <option>Avea İletişim Hizmetleri A.Ş Çalışanları</option> 
                            <option>Bilkent Çalışanları Öğret. Gör.</option> 
                             
                            <option>Bursa Tofaş Çalışanları ve Eşleri</option> 
                            <option>Doktor Poliçesi Olan Doktorlar ve Diş hekimleri</option> 
                            <option>Erdemir ve Erdemir Vakfi Üyeleri</option> 
                            <option>Eyüpoğlu Okulları Çalışanları</option> 
                                                                                                                                                  </select> 
                        </font></td> 
                      </tr> 
                      
  					<td height="20" colspan="2" align="right" vAlign="middle"><div align="center" class="style11">--AKSESUAR DURUMU BİLGİLERİ--</div></td> 
                      <tr>

ARACINIZDA AKSESUAR VARMI :

php kasko teklif formu lütfen yardım

Benzer içerikler