Simple Contact us Form in HTML and PHP

Form created using HTML

This is just an example form for you, if you need something a little different from the one below, then please have a look through our other web pages (we have many other forms available).

Copy and Paste this code directly into your HTML web page. 

<form name="htmlform" method="post" action="html_form_send.php">

<table width="450px">

</tr>

<tr>

 <td valign="top">

  <label for="first_name">First Name *</label>

 </td>

 <td valign="top">

  <input  type="text" name="first_name" maxlength="50" size="30">

 </td>

</tr>

<tr>

 <td valign="top"">

  <label for="last_name">Last Name *</label>

 </td>

 <td valign="top">

  <input  type="text" name="last_name" maxlength="50" size="30">

 </td>

</tr>

<tr>

 <td valign="top">

  <label for="email">Email Address *</label>

 </td>

 <td valign="top">

  <input  type="text" name="email" maxlength="80" size="30">

 </td>

</tr>

<tr>

 <td valign="top">

  <label for="telephone">Telephone Number</label>

 </td>

 <td valign="top">

  <input  type="text" name="telephone" maxlength="30" size="30">

 </td>

</tr>

<tr>

 <td valign="top">

  <label for="comments">Comments *</label>

 </td>

 <td valign="top">

  <textarea  name="comments" maxlength="1000" cols="25" rows="6">
</textarea>

 </td>

</tr>

<tr>

 <td colspan="2" style="text-align:center">

  <input type="submit" value="Submit">  

 </td>

</tr>

</table>

</form>

HTML Form Processing. PHP Script

You also need to save this PHP script. This is used to capture the form submissions and

send you an email.You will need to change two parts of this. You need to set your email address.

Save this file as html_form_send.php 

<?php

if(isset($_POST['email'])) {

     

    // CHANGE THE TWO LINES BELOW

    $email_to = "you@yourdomain.com";

     

    $email_subject = "website html form submissions";

     

     

    function died($error) {

        // your error code can go here

        echo "We are very sorry, but there were error(s) found with the
form you submitted. ";

        echo "These errors appear below.<br /><br />";

        echo $error."<br /><br />";

        echo "Please go back and fix these errors.<br /><br />";

        die();

    }

     

    // validation expected data exists

    if(!isset($_POST['first_name']) ||

        !isset($_POST['last_name']) ||

        !isset($_POST['email']) ||

        !isset($_POST['telephone']) ||

        !isset($_POST['comments'])) {

        died('We are sorry, but there appears to be a problem
with the form you submitted.');      

    }

     

    $first_name = $_POST['first_name']; // required

    $last_name = $_POST['last_name']; // required

    $email_from = $_POST['email']; // required

    $telephone = $_POST['telephone']; // not required

    $comments = $_POST['comments']; // required

     

    $error_message = "";

    $email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+
\.[A-Za-z]{2,4}$/';

  if(!preg_match($email_exp,$email_from)) {

    $error_message .= 'The Email Address you entered does not
appear to be valid.<br />';

  }

    $string_exp = "/^[A-Za-z .'-]+$/";

  if(!preg_match($string_exp,$first_name)) {

    $error_message .= 'The First Name you entered does not appear to
be valid.<br />';

  }

  if(!preg_match($string_exp,$last_name)) {

    $error_message .= 'The Last Name you entered does not
appear to be valid.<br />';

  }

  if(strlen($comments) < 2) {

    $error_message .= 'The Comments you entered do not
appear to be valid.<br />';

  }

  if(strlen($error_message) > 0) {

    died($error_message);

  }

    $email_message = "Form details below.\n\n";

     

    function clean_string($string) {

      $bad = array("content-type","bcc:","to:","cc:","href");

      return str_replace($bad,"",$string);

    }

     

    $email_message .= "First Name: ".clean_string($first_name)."\n";

    $email_message .= "Last Name: ".clean_string($last_name)."\n";

    $email_message .= "Email: ".clean_string($email_from)."\n";

    $email_message .= "Telephone: ".clean_string($telephone)."\n";

    $email_message .= "Comments: ".clean_string($comments)."\n";

     

     

// create email headers

$headers = 'From: '.$email_from."\r\n".

'Reply-To: '.$email_from."\r\n" .

'X-Mailer: PHP/' . phpversion();

@mail($email_to, $email_subject, $email_message, $headers); 

?>

<!-- place your own success html below -->

Thank you for contacting us. We will be in touch with you very soon.

<?php

}

die();

?>

Example HTML Form

First Name *
Last Name *
Email Address *
Telephone Number
Comments *
( HTML Form )