<!--------------------------------------->
<!--    Plexus Interactive M/2, Inc    -->
<!-- Paul Zimmerman paul@plexmedia.com -->
<!--------------------------------------->

<?

	require ("defaults.php");

	if ($mode == "Cancel") {

		header("Location: $PHP_SELF?");

	} elseif ($mode == "Submit") {

		// REQUIRED FIELDS
		if (!$first_name) { $b[] = "You need to enter your First Name."; }
		if (!$last_name) { $b[] = "You need to enter your Last Name."; }
		if (!$address) { $b[] = "You need to enter your Address."; }
		if (!$city) { $b[] = "You need to enter your City."; }
		if (!$state) { $b[] = "You need to enter your State."; }
		if (!$zip) { $b[] = "You need to enter your Zip."; }
		if (!eregi("^([a-z0-9_]|\\-|\\.)+@(([a-z0-9_]|\\-)+\\.)+[a-z]{2,4}$",$email)) { $b[] = "You need to enter a valid Email Address."; }

		if (!$b) :

			$today = date("Y-m-d H:i:s");
			$ip = getenv("REMOTE_ADDR");

			// INSERT RECORD
			$sql = "INSERT INTO contact SET 
					first_name = '$first_name',
					last_name = '$last_name',
					company = '$company',
					address = '$address',
					address2 = '$address2',
					city = '$city',
					state = '$state',
					zip = '$zip',
					phone = '$phone',
					fax = '$fax',
					email = '$email',
					callme = '$callme',
					callme_income_tax = '$callme_income_tax',
					callme_estate_planning = '$callme_estate_planning',
					callme_probate_guardinship = '$callme_probate_guardinship',
					callme_corporate_law = '$callme_corporate_law',
					callme_real_estate = '$callme_real_estate',
					callme_international_tax = '$callme_international_tax',
					callme_asset_protection = '$callme_asset_protection',
					today = '$today',
					ip = '$ip'";

			mysql_query($sql);

			// STRIP SLASHES
			$first_name = stripslashes($first_name);
			$last_name = stripslashes($last_name);
			$company = stripslashes($company);
			$address = stripslashes($address);
			$address2 = stripslashes($address2);
			$city = stripslashes($city);
			$state = stripslashes($state);
			$zip = stripslashes($zip);
			$phone = stripslashes($phone);
			$fax = stripslashes($fax);
			$email = stripslashes($email);
			$callme = stripslashes($callme);
			$callme_income_tax = stripslashes($callme_income_tax);
			$callme_estate_planning = stripslashes($callme_estate_planning);
			$callme_probate_guardinship = stripslashes($callme_probate_guardinship);
			$callme_corporate_law = stripslashes($callme_corporate_law);
			$callme_real_estate = stripslashes($callme_real_estate);
			$callme_international_tax = stripslashes($callme_international_tax);
			$callme_asset_protection = stripslashes($callme_asset_protection);

			// EMAIL MESSAGE
			$to = "info@therrelbaisden.com";
			$from = "webuser@therrelbaisden.com";
			$subject = "TherrelBaisden.com Contact Form Signup";

			$message = "TherrelBaisden.com Contact Form Details:\n\n";
			$message .= "First Name : ".$first_name."\n";
			$message .= "Last Name : ".$last_name."\n";
			$message .= "Company : ".$company."\n";
			$message .= "Address : ".$address."\n";
			$message .= "Address2 : ".$address2."\n";
			$message .= "City : ".$city."\n";
			$message .= "State : ".$state."\n";
			$message .= "Zip : ".$zip."\n";
			$message .= "Phone : ".$phone."\n";
			$message .= "Fax : ".$fax."\n";
			$message .= "Email : ".$email."\n";
			$message .= "Callme : ".$callme."\n";
			$message .= "Callme Income Tax : ".$callme_income_tax."\n";
			$message .= "Callme Estate Planning : ".$callme_estate_planning."\n";
			$message .= "Callme Probate Guardinship : ".$callme_probate_guardinship."\n";
			$message .= "Callme Corporate Law : ".$callme_corporate_law."\n";
			$message .= "Callme Real Estate : ".$callme_real_estate."\n";
			$message .= "Callme International Tax : ".$callme_international_tax."\n";
			$message .= "Callme Asset Protection : ".$callme_asset_protection."\n";

			mail($to, $subject, $message, "From: ".$from);

			header("Location: contact-thank.html");
			exit();

		else:

			// REMOVE QUOTES AND STRIP SLASHES
			$first_name = stripslashes(eregi_replace('"',"&quot;",$first_name));
			$last_name = stripslashes(eregi_replace('"',"&quot;",$last_name));
			$company = stripslashes(eregi_replace('"',"&quot;",$company));
			$address = stripslashes(eregi_replace('"',"&quot;",$address));
			$address2 = stripslashes(eregi_replace('"',"&quot;",$address2));
			$city = stripslashes(eregi_replace('"',"&quot;",$city));
			$state = stripslashes(eregi_replace('"',"&quot;",$state));
			$zip = stripslashes(eregi_replace('"',"&quot;",$zip));
			$phone = stripslashes(eregi_replace('"',"&quot;",$phone));
			$fax = stripslashes(eregi_replace('"',"&quot;",$fax));
			$email = stripslashes(eregi_replace('"',"&quot;",$email));
			$callme = stripslashes(eregi_replace('"',"&quot;",$callme));
			$callme_income_tax = stripslashes(eregi_replace('"',"&quot;",$callme_income_tax));
			$callme_estate_planning = stripslashes(eregi_replace('"',"&quot;",$callme_estate_planning));
			$callme_probate_guardinship = stripslashes(eregi_replace('"',"&quot;",$callme_probate_guardinship));
			$callme_corporate_law = stripslashes(eregi_replace('"',"&quot;",$callme_corporate_law));
			$callme_real_estate = stripslashes(eregi_replace('"',"&quot;",$callme_real_estate));
			$callme_international_tax = stripslashes(eregi_replace('"',"&quot;",$callme_international_tax));
			$callme_asset_protection = stripslashes(eregi_replace('"',"&quot;",$callme_asset_protection));

		endif;

	}

?>

<HTML>
<HEAD>
<TITLE>Therrel Baisden</TITLE>
<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1">
<script language="JavaScript">
<!--
function MM_swapImgRestore() { //v3.0
  var i,x,a=document.MM_sr; for(i=0;a&&i<a.length&&(x=a[i])&&x.oSrc;i++) x.src=x.oSrc;
}

function MM_preloadImages() { //v3.0
  var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array();
    var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++)
    if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}}
}

function MM_findObj(n, d) { //v4.0
  var p,i,x;  if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) {
    d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);}
  if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n];
  for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document);
  if(!x && document.getElementById) x=document.getElementById(n); return x;
}

function MM_swapImage() { //v3.0
  var i,j=0,x,a=MM_swapImage.arguments; document.MM_sr=new Array; for(i=0;i<(a.length-2);i+=3)
   if ((x=MM_findObj(a[i]))!=null){document.MM_sr[j++]=x; if(!x.oSrc) x.oSrc=x.src; x.src=a[i+2];}
}
//-->
</script>
</HEAD>
<BODY BGCOLOR=#FFFFFF onLoad="MM_preloadImages('images/inside-nav-on_01.jpg','images/inside-nav-on_02.jpg','images/inside-nav-on_03.jpg','images/inside-nav-on_04.jpg','images/inside-nav-on_05.jpg','images/inside-nav-on_06.jpg')" text="#000000" link="#336699" vlink="#0000FF">

<table width="700" border="0" cellspacing="0" cellpadding="0">
  <tr align="left" valign="top"> 
    <td width="230"><img src="images/inside_01.jpg" width=230 height=56></td>
    <td width="470"><img src="images/inside_02.jpg" width=470 height=56></td>
  </tr>
  <tr align="left" valign="top"> 
    <td width="230"><img src="images/inside_03.jpg" width=230 height=120><br>
      <table border=0 cellpadding=0 cellspacing=0>
        <tr> 
          <td> <a href="firm.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('a1','','images/inside-nav-on_01.jpg',1)"><img src="images/inside-nav_01.jpg" width=230 height=23 name="a1" border="0"></a></td>
        </tr>
        <tr> 
          <td> <a href="att.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('b1','','images/inside-nav-on_02.jpg',1)"><img src="images/inside-nav_02.jpg" width=230 height=24 name="b1" border="0"></a></td>
        </tr>
        <tr> 
          <td> <a href="practice.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('c1','','images/inside-nav-on_03.jpg',1)"><img src="images/inside-nav_03.jpg" width=230 height=24 name="c1" border="0"></a></td>
        </tr>
        <tr> 
          <td> <a href="plan.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('d1','','images/inside-nav-on_04.jpg',1)"><img src="images/inside-nav_04.jpg" width=230 height=24 name="d1" border="0"></a></td>
        </tr>
        <tr> 
          <td> <a href="contact.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('e1','','images/inside-nav-on_05.jpg',1)"><img src="images/inside-nav_05.jpg" width=230 height=24 name="e1" border="0"></a></td>
        </tr>
        <tr> 
          <td> <a href="directions.html" onMouseOut="MM_swapImgRestore()" onMouseOver="MM_swapImage('f1','','images/inside-nav-on_06.jpg',1)"><img src="images/inside-nav_06.jpg" width=230 height=30 name="f1" border="0"></a></td>
        </tr>
      </table>
      <p><img src="images/inside_07.jpg" width=230 height=139 usemap="#mappMap" border="0">
        <map name="mappMap"> 
          <area shape="rect" coords="27,84,203,103" href="tax.html">
          <area shape="rect" coords="26,106,205,125" href="hot.html">
        </map>
      </p>
    </td>
    <td rowspan="2"> 
      <table width="440" border="0" cellspacing="10" cellpadding="0">
        <tr> 
          <td align="left" valign="top"> 
<? if (!$b): ?>
            <p align="JUSTIFY"><b><font size="2" face="Verdana" color="#336699">CONTACT 
              US</font></b></p>
            <p align="center"><font face="Verdana"><font size="2"><a href="mailto:Ndaniels@therrelbaisden.com">Nicholas 
              M. Daniels</a> | <a href="mailto:ERose@therrelbaisden.com">Ellen 
              Rose</a> | </font></font><font face="Verdana"><font size="2"><a href="mailto:FStanton@therrelbaisden.com">Fred 
              R. Stanton</a></font></font></p>
            <p align="center"><font face="Verdana"><font size="2"><a href="mailto:Jfeuerman@therrelbaisden.com">Jonathan 
              Feuerman</a> | <a href="mailto:MHasner@therrelbaisden.com">Mark 
              M. Hasner</a> | </font></font><font face="Verdana"><font size="2"><a href="mailto:DDarlow@therrelbaisden.com">David 
              Darlow</a><br>
              </font></font></p>
            <hr width="90%">
            <font face="Verdana"><font size="2"> </font></font>
<? endif; ?>

<?
	if ($b) {
		foreach ($b as $item) {
			print "<center><font color=\"RED\" face=\"Verdana\" size=\"2\"><b>$item</b></font></center>";
		}
		print "<br>";
	}
?>

<form method="post" action="<?=$PHP_SELF?>">
              <table width="425" border="0" cellspacing="2" cellpadding="2">
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">First Name:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="first_name" size="30" maxlength="255" value="<?=$first_name?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Last Name:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="last_name" size="30" maxlength="255" value="<?=$last_name?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Company Name:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="company" size="30" maxlength="255" value="<?=$company?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Address 1:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="address" size="30" maxlength="255" value="<?=$address?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Address 2:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="address2" size="30" maxlength="255" value="<?=$address2?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">City:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="city" size="30" maxlength="255" value="<?=$city?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"><font face="Verdana" size="2">State:</font></td>
                  <td width="288"> 
                    <select name="state" size="1" maxlength="255">
<? if($state): ?>
	<option value="<?=$state?>" SELECTED><?=$state?></option>
<? else: ?>
	<option value="">Not Selected </option>
<? endif; ?>
                      <option value="">Not Selected</option>
                      <option value="Alabama">Alabama</option>
                      <option value="Alaska">Alaska</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="Florida">Florida</option>
                      <option value="Georgia">Georgia</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="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">New York</option>
                      <option value="North Carolina">North Carolina</option>
                      <option value="North Dakota">North Dakota</option>
                      <option value="Ohio">Ohio</option>
                      <option value="Oklahoma">Oklahoma</option>
                      <option value="Oregon">Oregon</option>
                      <option value="Pennsylvania">Pennsylvania</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="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>
                    </select>
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">ZIP Code:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="zip" size="10" maxlength="255" value="<?=$zip?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Phone:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="phone" size="15" maxlength="255" value="<?=$phone?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">Fax:</font> </td>
                  <td width="288"> 
                    <input type="text" name="fax" size="15" maxlength="255" value="<?=$fax?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td width="123"> <font face="Verdana" size="2">E-mail Address:</font> 
                  </td>
                  <td width="288"> 
                    <input type="text" name="email" size="30" maxlength="255" value="<?=$email?>">
                  </td>
                </tr>
                <tr valign="top"> 
                  <td colspan="2"> 
                    <p><font face="Verdana, Arial, Helvetica" size="2">From time 
                      to time we will announce new legal developments, estate 
                      planning techniques, or tax law changes in our firm's newsletter.</font> 
                    </p>
                    <p><font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme" value="Y"<?if($callme=="Y"){print" CHECKED";}?>>
                      Yes, I would like to register for these e-mail announcements.</font> 
                    </p>
                  </td>
                </tr>
                <tr valign="top"> 
                  <td colspan="2"> 
                    <p><font size="2" face="Verdana, Arial, Helvetica">I am interested 
                      in the following topics:</font> </p>
                    <p><font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_income_tax" value="Y"<?if($callme_income_tax=="Y"){print" CHECKED";}?>>
                      Income Tax</font> <br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_estate_planning" value="Y"<?if($callme_estate_planning=="Y"){print" CHECKED";}?>>
                      Estate Planning</font><br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_probate_guardinship" value="Y"<?if($callme_probate_guardinship=="Y"){print" CHECKED";}?>>
                      Probate And Guardianship</font> <br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_corporate_law" value="Y"<?if($callme_corporate_law=="Y"){print" CHECKED";}?>>
                      Corporate Law</font><br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_real_estate" value="Y"<?if($callme_real_estate=="Y"){print" CHECKED";}?>>
                      Real Estate</font><br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_international_tax" value="Y"<?if($callme_international_tax=="Y"){print" CHECKED";}?>>
                      International Tax Planning</font><br>
                      <font face="Verdana" size="2"> 
                      <input type="checkbox" name="callme_asset_protection" value="Y"<?if($callme_asset_protection=="Y"){print" CHECKED";}?>>
                      Asset Protection</font></p>
                  </td>
                </tr>
                <tr valign="top"> 
                  <td colspan="2"> 
                    <div align="center">
                      <input type="submit" name="mode" value="Submit">
                      <input type="submit" name="mode" value="Cancel">
                    </div>
                  </td>
                </tr>
              </table>
            </form>
            <p align="JUSTIFY">&nbsp;</p>
          </td>
        </tr>
      </table>
    </td>
  </tr>
  <tr align="left" valign="top"> 
    <td> 
      <p>&nbsp;</p>
    </td>
  </tr>
</table>
<p>
<map name="mapp"> 
    <area shape="rect" coords="27,84,203,103" href="tax.html">
    <area shape="rect" coords="26,106,205,125" href="hot.html">
  </map>
</p>
</BODY>
</HTML>