1. div>
2.   <div id="blocform">
3. <Form METHOD="POST"ACTION="http://www.toto.com/test/form2mail.php" >
4.      <input type="hidden" value="success.shtml" name="success" />
5.   <input type="hidden" value="failure.shtml" name="failure" />
6.   <input type="hidden" value="toto" name="titresite" />
7.   <input type="hidden" value="Contact " name="subject" />

1. <p />
2. <p align="left"><span class="ContText"><b>Contacter </b></span></p>
3. <p align="left"><span class="FormText">Civilit&eacute; * : <input type="radio" value="Madame" name="civilitees" class="intext" /> Madame <input type="radio" value="Mademoiselle" name="civilitees" class="intext" /> Mademoiselle <input type="radio" value="Monsieur" name="civilitees" class="intext" /> Monsieur.</span></p>
4.   <hr />
5. <p align="left" class="ContText">Votre Nom <span class="FormText">*</span> :<br /><input type="text" name="required-Votre-Nom" size="24" style="width:99%" class="intext" /></p>
6. <p align="left" class="ContText">Votre Pr&eacute;nom :<br /><input type="text" name="Votre-Prenom" size="24" style="width:99%" class="intext" /></p>
8. <p align="left" class="ContText">Votre adresse email <span class="FormText">*</span> :<br /><input type="text" name="required-email" size="24" style="width:99%" class="intext" /></p>
10.    <p align="left" class="ContText">
11.    Merci de s&eacute;lectionner un statut en utilisant le menu ci-dessous ! <span class="FormText">*</span>
12.    <select name="required-Statut" size="1" style="width:auto">
13.     <option value="aucun">Vous &ecirc;tes ...</option>
14.     <option value="Particulier">Particulier</option>
15.     <option value="Profession libŽrale">Profession lib&eacute;rale</option>
16.     <option value="Entreprise">Entreprise</option>
17.     <option value="Association">Association</option>
18.     <option value="Administration et collectivitŽ">Administration et collectivit&eacute;</option>
19.     <option value="Autre">Autre</option>
20.    </select></p>
21. <p align="left" class="ContText">Pr&eacute;ciser le nom de l'entreprise, association, collectivit&eacute; ...  <br /><input type="text" name="entreprise" size="24" style="width:99%" class="intext" /></p>
22. <p align="left" class="ContText">Contenu du message <span class="FormText">*</span> :<br /><textarea name="message" cols="40" rows="10" style="font-size:10pt;width:99%" class="intext"></textarea></p>
23.   <p align="center"><input type="reset" value="effacer" class="select" style="width:45%" /> <input type="submit" value="envoyer ce message" class="select" style="width:45%" /></p>
24. </form>
25.   </div>

<?php 
# You can use this script to submit your forms or to receive orders by email.
$MailToAddress = "toto@toto.com"; // your email address
$redirectURL = "http://www.toto.com/test/success.shtml"; // the URL of the thank you page.
$MailSubject = "[Message from the contact form]"; // the subject of the email
$sendHTML = FALSE; //set to "false" to receive Plain TEXT e-mail
$serverCheck = TRUE; // if, for some reason you can't send e-mails, set this to "false"
# copyright 2006 Web4Future.com =================== READ THIS ===================================================
# If you are asking for a name and an email address in your form, you can name the input fields "name" and "email".
# If you do this, the message will apear to come from that email address and you can simply click the reply button to answer it.
# To block an IP, simply add it to the blockip.txt text file.
# CHMOD 777 the blockip.txt file (run "CHMOD 777 blockip.txt", without the double quotes) 
# This is needed because the script tries to block the IP that tried to hack it
# If you have a multiple selection box or multiple checkboxes, you MUST name the multiple list box or checkbox as "name[]" instead of just "name" 
# you must also add "multiple" at the end of the tag like this: <select name="myselectname[]" multiple> 
# you have to do the same with checkboxes
/*****************************************************************
 Web4Future Easiest Form2Mail (GPL).
 Copyright (C) 1998-2006 Web4Future.com All Rights Reserved. 
 http://www.Web4Future.com/
 This script was written by George L. & Calin S. from Web4Future.com
 This program is free software; you can redistribute it and/or modify
 it under the terms of the GNU General Public License as published by
 the Free Software Foundation; either version 2 of the License, or
 (at your option) any later version.
 This program is distributed in the hope that it will be useful,
 but WITHOUT ANY WARRANTY; without even the implied warranty of
 MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
 GNU General Public License for more details.
*****************************************************************/
# DO NOT EDIT BELOW THIS LINE UNLESS YOU KNOW WHAT YOU ARE DOING ===================================================
$w4fver =  "2.2";
$ip = ($_SERVER['HTTP_X_FORWARDED_FOR'] == "" ? $_SERVER['REMOTE_ADDR'] : $_SERVER['HTTP_X_FORWARDED_FOR']);
//function blockIP
function blockip($ip) {
 $handle = @fopen("blockip.txt", 'a');
 @fwrite($handle, $ip."\n" );
 @fclose($handle); 
}
$w4fx = stristr(file_get_contents('blockip.txt'),getenv('REMOTE_ADDR')); 
if ($serverCheck) { 
 if (preg_match ("/".str_replace("www.", "", $_SERVER["SERVER_NAME"])."/i", $_SERVER["HTTP_REFERER"])) { $w4fy = TRUE; } else { $w4fy = FALSE; }
} else { $w4fy = TRUE; }
if (($w4fy === TRUE) && ($w4fx === FALSE)) {
$w4fMessage = "<!DOCTYPE HTML PUBLIC \"-//W3C//DTD HTML 4.01 Transitional//EN\" \"http://www.w3.org/TR/html4/loose.dtd\"><html>\n<head><meta http-equiv=\"Content-Type\" content=\"text/html; charset=iso-8859-1\"></head><body><font face=3Dverdana size=3D2>";
if (count($_GET) >0) {
 reset($_GET);
 while(list($key, $val) = each($_GET)) {
  $GLOBALS[$key] = $val;
  if (is_array($val)) { 
   $w4fMessage .= "<b>$key:</b> ";
   foreach ($val as $vala) { 
    $vala =stripslashes($vala);
    $vala = htmlspecialchars($vala);
    if (trim($vala)) { if (stristr($vala,"Content-Type:" ) || stristr($vala,"MIME-Version" ) || stristr($vala,"Content-Transfer-Encoding" ) || stristr($vala,"bcc:" )) { blockip($ip); die("ILLEGAL EXECUTION DETECTED!" ); } }
    $w4fMessage .= "$vala, ";
   } 
   $w4fMessage .= "<br>\n";
  }  
  else {
   $val = stripslashes($val);
   if (trim($val)) { if (stristr($val,"Content-Type:" ) || stristr($val,"MIME-Version" ) || stristr($val,"Content-Transfer-Encoding" ) || stristr($val,"bcc:" )) { blockip($ip); die("ILLEGAL EXECUTION DETECTED!" ); } }
   if (($key == "Submit" ) || ($key == "submit" )) { }  
   else {  if ($val == "" ) { $w4fMessage .= "$key: - <br>\n"; }
     else { $w4fMessage .= "<b>$key:</b> $val<br>\n"; }
   }
  }
 } // end while
}//end if
else {
 reset($_POST);
 while(list($key, $val) = each($_POST)) {
  $GLOBALS[$key] = $val;
  if (is_array($val)) { 
   $w4fMessage .= "<b>$key:</b> ";
   foreach ($val as $vala) { 
    $vala =stripslashes($vala);
    $vala = htmlspecialchars($vala);
    if (trim($vala)) { if (stristr($vala,"Content-Type:" ) || stristr($vala,"MIME-Version" ) || stristr($vala,"Content-Transfer-Encoding" ) || stristr($vala,"bcc:" )) {blockip($ip); die("ILLEGAL EXECUTION DETECTED!" ); } }    
    $w4fMessage .= "$vala, ";
   } 
   $w4fMessage .= "<br>\n";
  }  
  else {
   $val = stripslashes($val);
   if (trim($val)) { if (stristr($val,"Content-Type:" ) || stristr($val,"MIME-Version" ) || stristr($val,"Content-Transfer-Encoding" ) || stristr($val,"bcc:" )) {blockip($ip); die("ILLEGAL EXECUTION DETECTED!" ); } }
   if (($key == "Submit" ) || ($key == "submit" )) { }  
   else {  if ($val == "" ) { $w4fMessage .= "$key: - <br>\n"; }
     else { $w4fMessage .= "<b>$key:</b> $val<br>\n"; }
   }
  }
 } // end while
 }//end else
 $w4fMessage .= "<font size=3D1><br><br>\n Sender IP: ".$ip."</font></font></body></html>";
    $w4f_what = array("/To:/i", "/Cc:/i", "/Bcc:/i","/Content-Type:/i","/\n/" );
 $name = preg_replace($w4f_what, "", $name);
 $email = preg_replace($w4f_what, "", $email);
if (!$email) {$email = $MailToAddress;}
 $mailHeader = "From: $name <$email>\r\n";
 $mailHeader .= "Reply-To: $name <$email>\r\n";
 $mailHeader .= "Message-ID: <". md5(rand()."".time()) ."@". ereg_replace("www.","",$_SERVER["SERVER_NAME"]) .">\r\n";
 $mailHeader .= "MIME-Version: 1.0\r\n";
 if ($sendHTML) {
  $mailHeader .= "Content-Type: multipart/alternative;";   
  $mailHeader .= "  boundary=\"----=_NextPart_000_000E_01C5256B.0AEFE730\"\r\n";     
 }
 $mailHeader .= "X-Priority: 3\r\n";
 $mailHeader .= "X-Mailer: PHP/" . phpversion()."\r\n";
 $mailHeader .= "X-MimeOLE: Produced By Web4Future Easiest Form2Mail $w4fver\r\n";
 if ($sendHTML) { 
  $mailMessage = "This is a multi-part message in MIME format.\r\n\r\n"; 
  $mailMessage .= "------=_NextPart_000_000E_01C5256B.0AEFE730\r\n";
  $mailMessage .= "Content-Type: text/plain;   charset=\"ISO-8859-1\"\r\nContent-Transfer-Encoding: quoted-printable\r\n\r\n";   
  $mailMessage .= trim(strip_tags($w4fMessage))."\r\n\r\n";   
  $mailMessage .= "------=_NextPart_000_000E_01C5256B.0AEFE730\r\n";   
  $mailMessage .= "Content-Type: text/html;   charset=\"ISO-8859-1\"\r\nContent-Transfer-Encoding: quoted-printable\r\n\r\n";   
  $mailMessage .= "$w4fMessage\r\n\r\n";   
  $mailMessage .= "------=_NextPart_000_000E_01C5256B.0AEFE730--\r\n";   
 }
 if ($sendHTML === FALSE) {
  $mailHeader .= "Content-Type: text/plain;   charset=\"ISO-8859-1\"\r\nContent-Transfer-Encoding: quoted-printable\r\n\r\n";   
  $mailMessage .= trim(strip_tags($w4fMessage))."\r\n\r\n";   
 }
 if (!mail($MailToAddress, $MailSubject, $mailMessage,$mailHeader)) { echo "Error sending e-mail!";}
 else { header("Location: ".$redirectURL); } 
} else { echo "<center><font face=verdana size=3 color=red><b>ILLEGAL EXECUTION DETECTED!</b></font></center>";}
?>

1. <div id="main">  <!-- debut #main -->
2. <div id="container">
3. <div id="bloctext1">
4. <h3>Avec nos remerciements...</h3>
5. <p><h3><b>[civilitees] [required-Votre-Nom]</b>, nous venons d'enregistrer votre demande.</h3>
6.   </p>
7.   <p><span class="FormText">r&eacute;f&eacute;rence : [$REMOTE_ADDR].[$REMOTE_HOST]<br />[$HTTP_USER_AGENT]</span></p>
8. </div>
9. </div>