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"); $name = $_POST['name']; $email = $_POST['email']; $cat = $_POST['cat']; $result=MYSQL_QUERY("INSERT INTO applications (name,email,cat)". "VALUES ('$name', '$email', '$cat')")or die( "

Unable to select table

"); mysql_close(); $to = "fveap@earthlink.net"; $subject = "Application for Assistance"; $from = $_POST["Txt_fn_4_1"]; $headers = "From: application@fveap.org"; $forward = 0; $location = "index.html"; $date = date ("l, F jS, Y"); $time = date ("h:i A"); $msg = "Below is a new application for assistance. It was submitted on $date at $time.\n\n"; if ($_SERVER['REQUEST_METHOD'] == "POST") { foreach ($_POST as $key => $value) { $msg .= ucfirst ($key) ." : ". $value . "\n"; } } else { foreach ($_GET as $key => $value) { $msg .= ucfirst ($key) ." : ". $value . "\n"; } } mail($to, $subject, $msg, $headers); if ($forward == 1) { header ("Location:$location"); } else { echo "Thank you for the information. We will reply to your request as quickly as we can."; echo " "; echo $from; } } else { // close php so we can put in our code ?> How To Apply
Home Qualifications Application Kobi's Fund Please Help Us
Kobi's Fund
Please Help Us
We Remember
Other Resources
Application for Assistance
Please be aware that we are not able to assist with routine exams, vaccinations, Insulin maintenance, Spay/Neuter, etc.

*indicates required fields 
  *Phone Number:
  *eMail Address:
  *Kitty's Name & Age:
  *Veterinarian's Name:
  *Veterinarian's Address:
  *Veterinarian's Phone Number:
  *What is Wrong?:
  *Estinated Cost of Treatment?:
  *Has Treatement Started?:  Yes
  If Yes, Please Describe:
  *Has Treatment Been Completed?:  Yes
  *What Qualifies You for Assistance?:
  Other Qualifications?:
  *Other Important Information:

After filling the details above click on the SUBMIT button.
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