set_body("LD services request by $fname $lname <$email>\n See attachment."); $mail->add_attachment($message, "WLD".$wld_count, 'text/plain'); $mail->build_message(); $mail->send($LDS_SIGNUP_EMAIL,$LDS_SIGNUP_EMAIL, $SUPPORT_EMAIL, $SUPPORT_EMAIL,"LD services request by $fname $lname <$email>"); #mail($LDS_SIGNUP_EMAIL, "LD services request by $fname $lname <$email>", $message, "From: Web Store <". $SUPPORT_EMAIL. ">"); #echo "REGISTERED!"; include "static/lds_signup_success.php3"; include "static/lds_email.php3"; mail($email, "Long Distance services order by $fname $lname <$email>", $message, "From: Web Store <". $SUPPORT_EMAIL. ">"); # mysql_close(); exit(); } #end if (!count.. }#end if $submit ?> LD services - signup >

LD services signup

Your request cannot be accepted. Please enter correct information in the fields marked with '<<<'

";?>

 

Customer information
Business Name <<<";?>
First Name <<<";?>
Last Name <<<";?>
Birthdate (MM/DD/YYYY) / / <<<";?>
Home Phone Number - - <<<";?>
Fax Number - - <<<";?>
e-mail <<<";?>
Address Line #1 <<<";?>
Address Line #2
City <<<";?>
State <<<";?>
ZIP <<<";?>
Country code you call the most <<<";?>
SSN or FID (?) - - <<<";?>
Telephone numbers to switch a)  - - <<<";?>
b)  - - <<<";?>
c)  - - <<<";?>
Intrastate Long Distance?
Rate plan <<<";?>
Third Party Verification (TPV) ID number (?) <<<";?>

 

\n"; ?>