Do you or does a member of your family need, or foresee the need for, services of one or more of our providers?
"; } elseif ($partnerForm == true) { $inquiry_form = "Partner/Provider Inquiry"; echo "Does your business offer services or products that can be used by Services4Life Partners or their customers and clients?
"; } elseif ($correspondentForm == true) { $inquiry_form = "Services4Life Correspondent Inquiry"; echo "Does your business have customers or clients that need Services4Life Partner services?
"; echo "Services4Life offers generous referral commissions to Services4Life correspondents.
"; } else { $inquiry_form = "General Inquiry"; echo "Is there anything on this website you'd like us to tell you more about?
"; } ?>Please fill out the following inquiry form for more information.
Note: All * fields are required.
function selfURL() {
$s = empty($_SERVER["HTTPS"]) ? ''
: ($_SERVER["HTTPS"] == "on") ? "s"
: "";
$protocol = strleft(strtolower($_SERVER["SERVER_PROTOCOL"]), "/").$s;
$port = ($_SERVER["SERVER_PORT"] == "80") ? ""
: (":".$_SERVER["SERVER_PORT"]);
return $protocol."://".$_SERVER['SERVER_NAME'].$port.$_SERVER['REQUEST_URI'];
}
function strleft($s1, $s2) {
return substr($s1, 0, strpos($s1, $s2));
}
?>
if ($HTTP_SERVER_VARS["HTTP_X_FORWARDED_FOR"] != "") {
$IP = $HTTP_SERVER_VARS["HTTP_X_FORWARDED_FOR"];
$proxy = $HTTP_SERVER_VARS["REMOTE_ADDR"];
$host = @gethostbyaddr($HTTP_SERVER_VARS["HTTP_X_FORWARDED_FOR"]);
}
else {
$IP = $HTTP_SERVER_VARS["REMOTE_ADDR"];
$host = @gethostbyaddr($HTTP_SERVER_VARS["REMOTE_ADDR"]);
}
?>