"; include("logtrack.php"); $invalid=false; //echo "Post Request: " . $_POST['requestquote']; $getquote = $_POST['requestquote']; $modifyquote = $_POST['modifyquote']; $formtype = $_POST['formtype']; //echo "GetQuote: $getquote Formtype: $formtype
"; if($getquote=='MODIFY QUOTE' && $formtype=='modify') { if(!$instype && $modifyquote) {$instypeclass = "modcol1er"; $comper=true;} else {$instypeclass = "modcol1";} if(!$budget && $modifyquote) {$budgetclass = "modcol4er"; $comper=true;} else {$budgetclass = "modcol4";} if(!$maxage && $modifyquote) {$ageclass = "modcol2er"; $comper=true;} else {$ageclass = "modcol2";} if(!$applsex && $modifyquote) {$sexclass = "modcol2er"; $comper=true;} else {$sexclass = "modcol2";} if(!$spouse && $modifyquote) {$spouseclass = "modcol4er"; $comper=true;} else {$spouseclass = "modcol4";} //if(!$startdate && $modifyquote) {$dateclass = "modcol4er"; $comper=true;} else {$dateclass = "modcol4";} if($children=="" && $modifyquote) {$childrenclass = "modcol3er"; $comper=true;} else {$childrenclass = "modcol3";} if(!$smoker && $modifyquote) {$smokerclass = "modcol4er"; $comper=true;} else {$smokerclass = "modcol4";} } else { if(!$fname && $getquote) {$fnameclass="lbler1"; $comper=true;} else {$fnameclass="lbl1";} if(!$lname && $getquote) {$lnameclass="lbler2"; $comper=true;} else {$lnameclass="lbl2";} if(!$address1 && $getquote) {$add1class="lbler1"; $comper=true;} else {$add1class="lbl1";} if(!$city && $getquote) {$cityclass = "lbler1"; $comper=true;} else {$cityclass = "lbl1";} if(!$state && $getquote) {$stateclass="lbler2"; $comper=true;} else {$stateclass="lbl2";} if((!$zip || !zip_validate($zip)) && $getquote) {$zipclass="lbler2"; $comper=true;} else {$zipclass="lbl2";} if((!$phone || !phone_validate($phone)) && $getquote) {$phoneclass = "lbler1"; $comper=true;} else {$phoneclass = "lbl1";} if((!$email || !email_validate($email)) && $getquote) {$emailclass = "lbler2"; $comper=true;} else {$emailclass = "lbl2";} //if(!$besttime && $getquote) {$besttimeclass = "lbler120"; $comper=true;} else {$besttimeclass = "lbl120";} if(!$hearabout && $getquote) {$hearaboutclass = "lbler120"; $comper=true;} else {$hearaboutclass = "lbl120";} if(!$instype && $getquote) {$instypeclass = "lbler120"; $comper=true;} else {$instypeclass = "lbl120";} if(!$budget && $getquote) {$budgetclass = "lbler120"; $comper=true;} else {$budgetclass = "lbl120";} if(!$spouse && $getquote) {$spouseclass = "lbler120"; $comper=true;} else {$spouseclass = "lbl120";} if(!$maxage && $getquote) {$ageclass = "lbler120"; $comper=true;} else {$ageclass = "lbl120";} //if(!$startdate && $getquote) {$dateclass = "lbler120"; $comper=true;} else {$dateclass = "lbl120";} if($children==="" && $getquote) {$childrenclass = "lbler120"; $comper=true;} else {$childrenclass = "lbl120";} if(!$smoker && $getquote) {$smokerclass = "lbler120"; $comper=true;} else {$smokerclass = "lbl120";} if(!$applsex && $getquote) {$sexclass = "lbler120"; $comper=true;} else {$sexclass = "lbl120";} } // Set values for Form //$besttime_sel = sel_create($besttime_list, $besttime_list, $besttime, "besttime"); $hearabout_sel = sel_create($hearabout_list, $hearabout_list, $hearabout, "hearabout"); $instype_sel = sel_create($insurancetype_list, $insurancetype_list, $instype, "instype"); $state_sel = sel_create($state_list, $state_list, $state, "state"); $spouse_sel=radio_create ($yesno_list, $spouse, 'spouse'); $smokers_sel=radio_create ($yesno_list, $smoker, 'smoker'); //$date_sel = get_valid_start ($startdate); $applsex_sel = radio_create ($sex_list, $applsex, 'applsex'); $budget_sel = sel_create($budget_list, $budget_var, $budget, "budget"); // Process Quote Request if ($_POST['requestquote']) { if ($comper) { $errormsg .= "
Please complete the fields highlighted in RED and click on Submit Request.
"; } else { $qtval= array(); $qtval['fname'] = $fname; $qtval['lname'] = $lname; $qtval['address1'] = $address1; $qtval['address2'] = $address2; $qtval['city'] = $city; $qtval['state'] = $state; $qtval['zip'] = $zip; $qtval['phone'] = cleanphone($phone); $qtval['email'] = $email; $qtval['instype'] = $instype; $qtval['budget'] = $budget; $qtval['hearabout'] = $hearabout; $qtval['smoker']=$smoker; $qtval['spouse']=$spouse; $qtval['maxage']=$maxage; $qtval['children']=$children; $qtval['comment']=$comment; $qtval['applsex']=$applsex; $qtval['custid']=$custid; $qtval['cust_type']=$cust_type; $qtval['quoteid']=$quoteid; $cust_id = insert_customers($qtval); //echo "CustID[0] = (" . $cust_id[0] . ") CustID[1]=(".$cust_id[1] .")
"; if ($cust_id[0]) { $custid=$cust_id[0]; $cust_type = $cust_id[1]; $qtval['custid']=$custid; // *********** INSERT QUOTE IN INFORMATION ******************** $Referrer = str_replace('http://www.affordable-health-insurance-quote.net','',$_SERVER['HTTP_REFERER']); //echo "$Referrer
"; //echo "Page Change: " . $_SESSION[pagechange]."
"; if ($Referrer == "/final_quote.htm" || $_SESSION['pagechange']==1) { $qtval['quoteid']=$quoteid; } else { $quote_id = insert_quote_in($qtval); if ($quote_id[0]) { $qtval['quoteid']=$quote_id[0]; $quoteid = $quote_id[0]; } } //echo "QUOTE: " . $quote_id[0] . "
"; //echo "QUOTE: " . $quoteid . "
"; //echo "Quote Status: " . $quote_id[1] . "
"; // *********** INSERT QUOTE IN INFORMATION ******************** // *********** VALIDATE SERVICE AREA ******************** // 1-26-06 $ziparea = validate_statezip($state,$zip); $ziparea['valid']=true; if ($ziparea['valid']) {$errormsg .= "
Your request has been successfully processed. You will be hearing from us shortly.
"; $success=true; //echo "processing quote for $state
"; //echo "$state, $budget, $ziparea, $smoker, $instype, $zip, $applsex, $spouse, $children, $maxage
"; // 1-26-06 $quotein=get_quote($qtval,$ziparea); $quotein = ""; if ($quotein[0]) { $errormsg =$quotein[1]; $quoteout = $quotein[2]; $_SESSION['planquote'] = $quotein[3]; $success=true; } else { //$errormsg .= "
Your request experience an error. Please try submitting again.
"; $errormsg .= "
 
"; $success=false; $formtype = "request"; } } // Valid Zip Code else { // $errormsg .= "
We're sorry, but we are not licensed to sell health insurance in the state of $state or your zip code $zip. We will forward your information to an associate licensed to do business in your state. If the zip code entered or state selected is wrong, please change them and try again. Thank you for using Affordable-Health-Insurance-Quote.net.
"; $errormsg .= "
 
"; $formtype = "request"; $invalid="true"; } // Invalid Zip Code } else { //$errormsg .= "
Your request experience an error. Please try submitting again.
"; $errormsg .= "
 
"; $success=false; $formtype = "request"; } } } if ($success) { if(!$instype && $modifyquote) {$instypeclass = "modcol1er"; $comper=true;} else {$instypeclass = "modcol1";} if(!$budget && $modifyquote) {$budgetclass = "modcol4er"; $comper=true;} else {$budgetclass = "modcol4";} if(!$maxage && $modifyquote) {$ageclass = "modcol2er"; $comper=true;} else {$ageclass = "modcol2";} if(!$applsex && $modifyquote) {$sexclass = "modcol2er"; $comper=true;} else {$sexclass = "modcol2";} if(!$spouse && $modifyquote) {$spouseclass = "modcol4er"; $comper=true;} else {$spouseclass = "modcol4";} //if(!$startdate && $modifyquote) {$dateclass = "modcol4er"; $comper=true;} else {$dateclass = "modcol4";} if($children==="" && $modifyquote) {$childrenclass = "modcol3er"; $comper=true;} else {$childrenclass = "modcol3";} if(!$smoker && $modifyquote) {$smokerclass = "modcol4er"; $comper=true;} else {$smokerclass = "modcol4";} } $budgetout = "$" . str_replace("-","-$",$budget); $requestview = "
Contact Information
Name:
$fname $lname
Address 1:
$address1
"; if ($address2) {$requestview .="
Address 2:
$address2
";} $requestview .="
City:
$city
State:
$state
Zip:
$zip
Phone:
$phone
Email:
$email
Quick Quote Information
How you found us:
$hearabout
Policy Type:
$instype
Budget Range:
$budgetout
Oldest Age Covered:
$maxage
Gender of Applicant:
$applsex
Include Spouse:
$spouse
Any Nicotine Users:
$smoker
Number of Children
(<18 yrs.):
$children
"; if ($comment) {$requestview.="
$comment
";} $requestview .="
"; $stateplans = get_plans($state); $modifyform = "
Instant Quote Information
Policy Type:
$instype_sel
Budget Range:
$budget_sel
Oldest Age Covered:
            
Gender of Applicant:
$applsex_sel
Include Spouse:
$spouse_sel
Number of Children:
  (<18 yrs. old)
Any Nicotine Users:
$smokers_sel

   "; if ($stateplans) {$modifyform .="    $stateplans";} $modifyform .="       
"; $requestform = "
Contact Information
$state_sel
Instant Quote Information
$hearabout_sel
$instype_sel
$budget_sel
$applsex_sel
$spouse_sel
$smokers_sel
"; //echo "Success: $success GetQuote: $getquote QuoteID: $quoteid Cust_ID: (" . $cust_type . ") Form: $formtype
"; if($success && $getquote=='INSTANT QUOTE' && $cust_type=='New' && $formtype<>'modify') { $emailmsg = "Affordable-Health-Insurance-Quote.Net

Dear $fname,

Thank you for submitting your request for an affordable health insurance quote. We are reviewing your request, based on the information provided below. If you decided to receive a quote with our Instant Quote, it will be emailed to you in a separate email at this email address. Otherwise, we will be contacting you in less than 24 hours. Your Customer ID is $custid.

$requestview

Thank you for using Affordable Health Insurance Quote. If you would like to talk our support, please feel free to contact us at 512-879-1943.


Support Staff
Affordable Health Insurance Quote

"; $subject = "Thank you for using Affordable Health Insurance Quote"; $emailout= emailcomment("sales@affordable-health-insurance-quote.net", "$email", $subject, $emailmsg); if ($emailout) {$emailto=$email;} if ($emailout) { $errormsg .= "
An email has been sent to your confirming your request. Thank you.
";} $emailout= emailcomment("sales@affordable-health-insurance-quote.net", "mcas@affordable-health-insurance-quote.net", $subject, $emailmsg); if ($emailout) {$emailto.=", mcas@affordable-health-insurance-quote.net"; log_emails($emailto, $subject); } } if($invalid && $getquote=='INSTANT QUOTE' && $cust_type=='New' && $formtype<>'modify') { $emailmsg = "Affordable-Health-Insurance-Quote.Net

Dear $fname,

Thank you for submitting your request for an affordable health insurance quote. We are sorry that we are not licensed to serve in your state. We will forward your information to another Unicare Agent licensed for your state. Your Customer ID is $custid.

$requestview

Thank you for using Affordable Health Insurance Quote. If you would like to talk directly to an agent, please feel free to contact us at 800-970-2599.


Support
Support Staff

"; $subject = "Thank you for using Affordable Health Insurance Quote"; $emailout= emailcomment("sales@affordable-health-insurance-quote.net", "$email", $subject, $emailmsg); if ($emailout) {$emailto=$email;} if ($emailout) {$errormsg .= "
An email has been sent to your confirming your request. Thank you.
";} $emailout= emailcomment("sales@affordable-health-insurance-quote.net", "mcas@affordable-health-insurance-quote.net", $subject, $emailmsg); if ($emailout) { $emailto.=", mcas@affordable-health-insurance-quote.net"; log_emails($emailto, $subject); } } // End PHP Processing ?> Affordable Health Insurance Quote "; if (!$justlog) { $logvals = checklogin(); $userid= $logvals['userid']; $fname= $logvals['fname']; $lname= $logvals['lname']; } $LoggedIn = "Logged In: $userid"; $logimg = "logoff"; } else { $LoggedIn =""; $logimg = "login"; } echo "$screenheader"; echo "
"; if ($_SERVER['REQUEST_URI']=="/apply_online.htm") {echo "
 
";} else {echo "
 
" . $LoggedIn . " 
\"Click
";} echo "
"; echo "$printheader"; ?>

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