<html>
<head><meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Freelance - Contact Form</title>

</head>
<body bgcolor="#FFFFFF">
    <?php
    error_reporting(0);
    echo '<pre>';
   // var_dump($_POST);
    echo '</pre>';
    foreach ($_POST as $key=>$value){
        if (is_array($value)){
             echo '<strong>'.ucfirst($key).'</strong> :';
            foreach ($value as $singlevalue){
                echo $singlevalue.', ';
            }
        }
        else
        {
      echo '<strong>'.ucfirst($key).'</strong> : '.$value.'<br>';
     
        }
        
    }
    
    
    ?>
    
    
  <p>
  </p><form action="leadgen.php" method="post" >

  <p align="center">
  <font face="Verdana, Arial, Helvetica" size="2" color="white"> </font> 
  <table border="0" width="600" cellpadding="10" align="center">
    <tbody><tr> 
      <td colspan="4" height="111"> 
        <div align="center">Logo Here</div>
      </td>
    </tr>
    <tr bgcolor="#CC0000"> 
      <td colspan="4"> 
        <div align="center"><font face="Verdana, Arial, Helvetica" size="2" color="white"> 
          <font size="1">TELL US ABOUT YOURSELF</font></font></div>
      </td>
    </tr>
    <tr> 
      <td align="right" valign="middle" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1"> NAME:</font></font></td>
      <td align="center" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="name" id="name" size="20" maxlength="40">
        </font></td>
      <td align="right" valign="middle" width="89" bgcolor="#999999"><font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">COMPANY:</font></font></td>
      <td align="center" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="company" id="company" size="20" maxlength="40">
        </font></td>
    </tr>
    <tr> 
      <td align="right" valign="middle" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1"> EMAIL:</font></font></td>
      <td align="center" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="email" id="email" size="20" maxlength="40">
        </font></td>
      <td align="right" valign="middle" width="89" bgcolor="#999999"><font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">PHONE:</font></font></td>
      <td align="center" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="phone" id="phone" size="20" maxlength="40">
        </font></td>
    </tr>
    <tr> 
      <td align="right" valign="middle" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1"> YOUR URL:</font></font></td>
      <td align="center" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="URL" size="20" maxlength="40">
        </font></td>
      <td align="right" valign="middle" width="89" bgcolor="#999999"><font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">CITY:</font></font></td>
      <td align="center" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="city" id="city" size="20" maxlength="40">
        </font></td>
    </tr>
    <tr align="left" valign="middle"> 
      <td align="right" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1"> STATE/<br>
        COUNTRY:</font></font></td>
      <td width="156" align="center" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="state" type="text" id="state" size="20" maxlength="200">
        </font></td>
      <td align="right" width="89" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1"> BEST WAY TO CONTACT YOU:</font></font></td>
      <td width="204" align="center" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="contact_by" type="radio" id="contact_by" value="Contact Phone">
        <font size="1"> PHONE</font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="radio" name="contact_by" value="Contact Email">
        <font size="1">EMAIL</font><font face="Verdana, Arial, Helvetica" size="2"></font></font></font></td>
    </tr>
    <tr bgcolor="#CC0000"> 
      <td colspan="4"> 
        <div align="center"><font face="Verdana, Arial, Helvetica" size="2" color="white"> 
          <font size="1">WHAT SORT OF SERVICES DO YOU NEED?</font></font></div>
      </td>
    </tr>
    <tr> 
      <td align="right" valign="top" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">WEBSITE:</font></font></td>
      <td align="left" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="web[]" value="Site Design">
        <font size="1">SITE DESIGN</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="web[]" value="Redesign">
        <font size="1">SITE REDESIGN</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="web[]" value="Store">
        <font size="1">ONLINE STORE<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="web[]" value="Marketing">
        <font size="1">MARKETING<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="web[]" value="Maintenance">
        <font size="1">MAINTENANCE</font></font></font></font></font></font></td>
      <td align="right" valign="top" width="89" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">PROGRAMMING:</font></font></td>
      <td align="left" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="programming[]" value="HTML/DHTML">
        <font size="1">HTML/DHTML</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="programming[]" value="PERL/CGI">
        <font size="1">CGI/PERL/C/C++</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="programming[]" value="Java">
        <font size="1">JAVA<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="programming[]" value="ASP">
        <font size="1">ASP<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="programming[]" value="XML">
        <font size="1">XML</font></font></font></font></font><font size="1"> </font></font></td>
    </tr>
    <tr> 
      <td align="right" valign="top" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">DATABASE:</font></font></td>
      <td align="left" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="database[]" value="Access">
        <font size="1">ACCESS</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="database[]" value="SQL">
        <font size="1">SQL</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="database[]" value="Sybase">
        <font size="1">SYBASE<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="database[]" value="Oracle">
        <font size="1">ORACLE</font></font></font></font><font size="1"> </font></font></td>
      <td align="right" valign="top" width="89" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">MULTIMEDIA:</font></font></td>
      <td align="left" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="multimedia[]" value="Flash">
        <font size="1">FLASH</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="multimedia[]" value="Quicktime">
        <font size="1">QUICKTIME</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="multimedia[]" value="Media Player">
        <font size="1">MEDIA PLAYER<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="multimedia[]" value="Real">
        <font size="1">REAL</font></font></font></font><font size="1"> </font></font></td>
    </tr>
    <tr> 
      <td align="right" valign="top" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">CORPORATE DESIGN:</font></font></td>
      <td align="left" valign="middle" width="156" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="corporate[]" value="Marketing Collateral">
        <font size="1">MARKETING </font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="corporate[]" value="Logos">
        <font size="1">LOGOS</font><font face="Verdana, Arial, Helvetica" size="2"><br>
        <input type="checkbox" name="corporate[]" value="Packaging">
        <font size="1">PACKAGING<br>
        </font><font face="Verdana, Arial, Helvetica" size="2"> 
        <input type="checkbox" name="corporate[]" value="Annual Reports">
        <font size="1">ANNUAL REPORTS</font></font></font></font><font size="1"> 
        </font></font></td>
      <td align="right" valign="middle" width="89" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#000000"> 
        <font size="1">OTHER:</font></font></td>
      <td align="left" valign="middle" width="204" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="other" id="other" size="20" maxlength="40">
        </font></td>
    </tr>
    <tr bgcolor="#CC0000"> 
      <td colspan="4"> 
        <div align="center"><font face="Verdana, Arial, Helvetica" size="2" color="white"> 
          <font size="1">ADDITIONAL COMMENTS</font></font></div>
      </td>
    </tr>
    <tr> 
      <td align="right" valign="middle" width="72" bgcolor="#999999"> <font face="Verdana, Arial, Helvetica" size="2" color="#FFFFFF"> 
        <font size="1"> <font color="#000000">COMMENTS:</font></font></font></td>
      <td align="left" valign="middle" colspan="3" bgcolor="#CCCCCC"><font face="Verdana, Arial, Helvetica" size="2"> 
        <input name="comments" id="comments" size="60" maxlength="100">
        </font></td>
    </tr>
    <tr> 
      <td valign="middle" colspan="3" align="right" bgcolor="#CC0000"> 
        <div align="center"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"></font> 
          <font face="Verdana, Arial, Helvetica, sans-serif" size="1" color="#FFFFFF">SUBMIT 
          FORM &gt;&gt;&gt;</font> </div>
      </td>
      <td valign="top" align="right" bgcolor="#CC0000"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> 
        <input name="send" type="submit" id="send" value="SEND">
        <input type="reset" value="RESET" onclick="resetform()" name="reset">
        </font></td>
    </tr>
  </tbody></table>
</p></form>



</body></html>