Online PHP editor | rfc for 3liND

<?php $rentalArray = array(); $rentalArray[] = array('id' => '', 'text' => ''); $rentalArray[] = array('id' => 'MobilityScooter', 'text' => 'Mobility Scooter'); $rentalArray[] = array('id' => 'PoweredWheelchair', 'text' => 'Powered Wheelchair'); $rentalArray[] = array('id' => 'ManualWheelchair', 'text' => 'Manual Wheelchair'); $rentalArray[] = array('id' => 'FoldingRamp', 'text' => 'Folding Ramp'); $rentalArray[] = array('id' => 'HospitalBed', 'text' => 'Hospital Bed'); $rentalArray[] = array('id' => 'OverbedTable', 'text' => 'Overbed Table'); $rentalArray[] = array('id' => 'PatientLifter', 'text' => 'Patient Lifter'); $rentalArray[] = array('id' => 'Trapeze', 'text' => 'Trapeze'); $rentalArray[] = array('id' => 'HipChair', 'text' => 'Hip Chair'); $rentalArray[] = array('id' => 'KneeWalker', 'text' => 'Knee Walker'); $rentalArray[] = array('id' => 'ShowerCommodeChair', 'text' => 'Rehab Shower Commode Chair'); $rentalArray[] = array('id' => 'Others', 'text' => 'Other Products'); $rentalArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalScooterArray = array(); $rentalScooterArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalScooterArray[] = array('id' => '3WheelScooter', 'text' => '3-Wheel Scooter'); $rentalScooterArray[] = array('id' => '4WheelScooter', 'text' => '4-Wheel Scooter'); $rentalScooterArray[] = array('id' => 'BariatricScooter', 'text' => 'Bariatric Scooter'); $rentalPowerWCArray = array(); $rentalPowerWCArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalPowerWCArray[] = array('id' => 'TravelPowerchair', 'text' => 'Travel Powered Wheelchair'); $rentalPowerWCArray[] = array('id' => 'StandardPowerchair', 'text' => 'Standard Powered Wheelchair'); $rentalPowerWCArray[] = array('id' => 'BariatricPowerchair', 'text' => 'Bariatric Powered Wheelchair'); $rentalManualWCArray = array(); $rentalManualWCArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalManualWCArray[] = array('id' => 'TransportWheelchair', 'text' => 'Transport Wheelchair'); $rentalManualWCArray[] = array('id' => 'StandardWheelhcair', 'text' => 'Standard Wheelhcair'); $rentalManualWCArray[] = array('id' => 'LightweightWheelchair', 'text' => 'Lightweight Wheelchair'); $rentalManualWCArray[] = array('id' => 'RecliningBackWheelchair', 'text' => 'Reclining Back Wheelchair'); $rentalManualWCArray[] = array('id' => 'BariatricWheelchair', 'text' => 'Bariatric Wheelchair'); $rentalManualWCArray[] = array('id' => 'ExtraWideBariatricWheelchair', 'text' => 'Extra Wide Bariatric Wheelchair'); $rentalRampsArray = array(); $rentalRampsArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalRampsArray[] = array('id' => '3FtRamp', 'text' => '3-Foot Folding Ramp'); $rentalRampsArray[] = array('id' => '6FtRamp', 'text' => '6-Foot Folding Ramp'); $rentalRampsArray[] = array('id' => '10FtRamp', 'text' => '10-Foot Folding Ramp'); $rentalHospitalBedArray = array(); $rentalHospitalBedArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalHospitalBedArray[] = array('id' => 'SemiElectricBed', 'text' => 'Semi-Electric Bed'); $rentalHospitalBedArray[] = array('id' => 'FullElectricBed', 'text' => 'Full-Electric Bed'); $rentalHospitalBedArray[] = array('id' => 'FullElectricBariatricBed', 'text' => 'Full-Electric Bariatric Bed'); $rentalLifterArray = array(); $rentalLifterArray[] = array('id' => 'Undecided', 'text' => 'Undecided / Unknown'); $rentalLifterArray[] = array('id' => 'ManualLifter', 'text' => 'Manual Patient Lifter'); $rentalLifterArray[] = array('id' => 'PoweredLifter', 'text' => 'Powered Patient Lifter'); $rentalDelivery = array(); $rentalDelivery[] = array('id' => '', 'text' => ''); $rentalDelivery[] = array('id' => 'Pickup', 'text' => 'Pickup at Homepro (Brooklyn, NY)'); $rentalDelivery[] = array('id' => 'Deliver', 'text' => 'Deliver to your home/hotel'); $rentalDeliveryState = array(); $rentalDeliveryState[] = array('id' => 'NY', 'text' => 'New York'); $rentalDeliveryState[] = array('id' => 'NJ', 'text' => 'New Jersey'); $rentalDeliveryState[] = array('id' => 'CT', 'text' => 'Connecticut'); ?> <div class="centerColumn" id="rentalReservationDefault"> <h1 id="rentalReservationDefaultHeading"><?php echo HEADING_TITLE; ?></h1> <?php if ($messageStack->size('rental_reservation') > 0) echo $messageStack->output('rental_reservation'); ?> <?php if (isset($_GET['action']) && ($_GET['action'] == 'success')) { ?> <div class="mainContent success"><?php echo TEXT_SUCCESS; ?></div> <div class="buttonRow"><?php echo zen_back_link() . zen_image_button(BUTTON_IMAGE_BACK, BUTTON_BACK_ALT) . '</a>'; ?></div> <?php } else { ?> <?php echo zen_draw_form('rental_reservation', zen_href_link(FILENAME_RENTAL_RESERVATION, 'action=send')); ?> <div id="rentalReservationContent" class="content"> <p>This is a testing message.</p> <fieldset id="rentalReservation-Contacts"> <legend>Rental Reservation Form</legend> <div class="alert forward"><?php echo FORM_REQUIRED_INFORMATION; ?></div> <br class="clearBoth" /> <label class="inputLabel" for="contact_firstname">First Name:</label> <?php echo zen_draw_input_field('contact_firstname', zen_output_string_protected($contact_firstname), ' size="30" id="contact_firstname"') . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" for="contact_lastname">Last Name:</label> <?php echo zen_draw_input_field('contact_lastname', zen_output_string_protected($contact_lastname), ' size="30" id="contact_lastname"') . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" for="contact_phone">Phone Number:</label> <?php echo zen_draw_input_field('contact_phone', zen_output_string_protected($contact_phone), ' size="30" id="contact_phone"') . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" for="contact_email">Email:</label> <?php echo zen_draw_input_field('contact_email', zen_output_string_protected($contact_email), ' size="30" id="contact_email"') . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" for="rental_renttype">Rental Category:</label> <?php echo zen_draw_pull_down_menu('rental_renttype', $rentalArray) . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelScooter" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalScooterArray) . '<span class="alertRS_S">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelPWC" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalPowerWCArray) . '<span class="alertRS_PWC">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelMWC" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalManualWCArray) . '<span class="alertRS_MWC">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelRamp" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalRampsArray) . '<span class="alertRS_R">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelHBed" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalHospitalBedArray) . '<span class="alertRS_HB">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelLifter" for="rental_rentsubtype">Rental Sub-Category:</label> <?php echo zen_draw_pull_down_menu('rental_rentsubtype', $rentalLifterArray) . '<span class="alertRS_L">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" for="rental_startdate">Start Date:</label> <?php //echo zen_draw_input_field('rental_startdate', zen_output_string_protected($rental_startdate), ' size="30" id="rental_startdate"'); ?> <input type="text" id="rental_startdate" name="rental_startdate" /> <br class="clearBoth" /> <label class="inputLabel" for="rental_enddate">End Date:</label> <?php //echo zen_draw_input_field('rental_enddate', zen_output_string_protected($contact_email), ' size="30" id="rental_enddate"'); ?> <input type="text" id="rental_enddate" name="rental_enddate" /> <br class="clearBoth" /> <label class="inputLabel" for="rental_delivery">Delivery/Pickup:</label> <?php echo zen_draw_pull_down_menu('rental_delivery', $rentalDelivery, '', 'id="rental_delivery"') . '<span class="alert">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelDA1" for="contact_deliver_address">Delivery Address:</label> <?php echo zen_draw_input_field('contact_deliver_address', zen_output_string_protected($contact_deliver_address), ' size="50" id="contact_deliver_address1"');?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelDA2" for="contact_deliver_address">Delivery Address:</label> <?php echo zen_draw_input_field('contact_deliver_address', zen_output_string_protected($contact_deliver_address), ' size="50" id="contact_deliver_address2"');?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelDC" for="contact_deliver_city">Delivery City:</label> <?php echo zen_draw_input_field('contact_deliver_city', zen_output_string_protected($contact_deliver_city), ' size="30" id="contact_deliver_city"');?> <br class="clearBoth" /> <label class="inputLabel" id="inputLabelDS" for="contact_deliver_state">Delivery State:</label> <?php echo zen_draw_pull_down_menu('rental_renttype', $rentalDeliveryState); ?> <br class="clearBoth" /> <label class="inputLabelDZ" id="inputLabelDZ" for="contact_deliver_zip">Delivery ZIP Code:</label> <?php echo zen_draw_input_field('contact_deliver_zip', zen_output_string_protected($contact_deliver_zip), ' size="5" id="contact_deliver_zip"') . '<span class="alertDZ">' . ENTRY_REQUIRED_SYMBOL . '</span>'; ?> <br class="clearBoth" /> <label for="comments">Comments:</label> <?php echo zen_draw_textarea_field('comments', 30, 4, zen_output_string_protected($comments), 'id="comments"'); ?> <br class="clearBoth" /> </fieldset> <div class="buttonRow back"><?php echo zen_back_link() . zen_image_button(BUTTON_IMAGE_BACK, BUTTON_BACK_ALT) . '</a>'; ?></div> <div class="buttonRow forward"><?php echo zen_image_submit(BUTTON_IMAGE_SEND, BUTTON_SEND_ALT); ?></div> <br class="clearBoth" /> </div> </form> <?php } ?> </div>

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