<h2>Scooter Premie Berekenen</h2>
[insert_php]
<?
session_start();
ini_set('display_errors', true);
error_reporting(E_ALL);
//Dit is een functie die de data trimt , slashes verwijdert en speciale karakters converteert.
function parse($data,$key)
{
$data = trim($data);
$data = stripslashes($data);
$data = htmlspecialchars($data);
$_SESSION[$key]=$data;
return $data;
}
//Dit is een functie die kijkt of een geldige datum is ingevoerd
function parse_datum($datum)
{
$dag = substr($datum,0,2);
$maand = substr($datum,3,2);
$jaar = substr($datum,6,4);
if(checkdate($maand, $dag, $jaar)==1)
{ return true; }
else
{ return false; }
}
//Dit is een functie die een fout print naar de gebruiker
function print_error($error)
{
echo "<span style='color: red; '>$error</span>";
}
//Dit is een functie die de leeftijd van de gebruiker berekent
function leeftijd($datum)
{
return floor((time() - strtotime($datum))/31556926);
}
//Dit is een functie die een premie berekent
function bereken_premie($leeftijd,$cc,$status)
{
$premie = 0;
if($status=="inwonend")
{
$leeftijd = 30;
}
if($leeftijd<26)
{
if($cc==125) $premie = 198.44;
else if($cc==250) $premie = 262.07;
else if($cc==300) $premie = 287.46;
else if($cc==400) $premie = 338.33;
else if($cc==500) $premie = 389.17;
}
else if($leeftijd>=26 && $leeftijd<=29)
{
if($cc==125) $premie = 166.68;
else if($cc==250) $premie = 219.93;
else if($cc==300) $premie = 241.02;
else if($cc==400) $premie = 283.41;
else if($cc==500) $premie = 325.77;
}
else if($leeftijd>29)
{
if($cc==125) $premie = 103.64;
else if($cc==250) $premie = 135.39;
else if($cc==300) $premie = 148.12;
else if($cc==400) $premie = 173.55;
else if($cc==500) $premie = 198.96;
}
return $premie;
}
//Dit is een functie die een email stuurt
function stuur_email($van,$naar,$onderwerp,$bericht)
{
$headers = "From: $van \r\n";
$headers .= "Reply-To: $van \r\n";
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-Type: text/html; charset=ISO-8859-1\r\n";
mail($naar,$onderwerp,$bericht,$headers);
}
$naamError = $datumError = $postcodeError = $emailError = $telError = $merkError = "";
$naam = $datum = $postcode = $email = $tel = $merk = $cc ="";
if(!empty($_SESSION['naam']))
$naam = $_SESSION['naam'];
if(!empty($_SESSION['datum']))
$datum = $_SESSION['datum'];
if(!empty($_SESSION['postcode']))
$postcode = $_SESSION['postcode'];
if(!empty($_SESSION['email']))
$email = $_SESSION['email'];
if(!empty($_SESSION['tel']))
$tel = $_SESSION['tel'];
$ongeval ="nee";
$maatschappij = "Nog geen verzekering";
if ($_SERVER["REQUEST_METHOD"] == "POST")
{
if(empty($_POST['naam']))
{ $naamError = "Naam is een verplicht veld"; }
else
{ $naam = parse($_POST['naam'],"naam"); }
if(empty($_POST['datum']))
{
$datumError = "Geboortedatum is een verplicht veld";
}
else
{
$datum = $_POST['datum'];
if(!parse_datum($datum))
$datumError = "De opgegeven geboortedatum is ongeldig";
}
if(empty($_POST['postcode']))
{ $postcodeError = "Postcode is een verplicht veld"; }
else
{ $postcode = parse($_POST['postcode'],"postcode"); }
if(empty($_POST['email']))
{ $emailError = "Email is een verplicht veld"; }
else
{ $email = parse($_POST['email'],"email"); }
if(empty($_POST['tel']))
{ $telError = "Telefoon is een verplicht veld"; }
else
{ $tel = parse($_POST['tel'],"tel"); }
if(empty($_POST['ongeval']))
{ $ongeval = "nee"; }
else
{ $ongeval = "ja";}
$status = $_POST['status'];
if(empty($_POST['maatschappij']))
{ $maatschappij = "Nog geen verzekering"; }
else
{ $maatschappij = parse($_POST['maatschappij']); }
if(empty($_POST['merk']))
{ $merkError = "Merk is een verplicht veld"; }
else
{ $merk = parse($_POST['merk'],"merk"); }
$cc = $_POST['cc'];
//Als er zich geen fouten voordoen , berekenen we de premie.
if($naamError=="" && $datumError=="" && $postcodeError=="" && $emailError=="" && $telError=="" && $merkError=="")
{
$leeftijd = leeftijd($datum); //bereken de leeftijd aan de hand van de geboortedatum
if($ongeval=="ja")
$premie = 0;
else
$premie = bereken_premie($leeftijd,$cc,$status); //bereken de premie
//De premie is berekent, we sturen de gebruiker een email met zijn premie voorstel, dit is het bericht dat we hem sturen
/****************************************************************************************************************/
$bericht = '<div align="center">
<img class="size-full wp-image-367 aligncenter" style="align: center;" alt="Jongverzekerd.be" src="http://jongverzekerdbe.webhosting.be/wp-content/uploads/2013/02/mail_top.png" width="600" height="149" />
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">Beste <strong>'.$naam.'</strong>,</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">U heeft een premieberekening gedaan op onze website. In deze e-mail vindt u het resultaat</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;"><strong>';
if($premie==0)
{
$bericht.="U heeft de afgelopen 5 jaar een ongeval gehad. Dit betekent dat wij u geen premie kunnen aanbieden. Onze excuses</strong></p>";
}
else
{
$bericht.="€ $premie *</strong></p>";
}
$bericht.=' <hr>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;"><strong>Uniek: verdien tot 500 euro per jaar!</strong></p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">U hebt vast en zeker nog wel kenissen die ook te veel betalen voor hun verzekering. Maak ze nu klant met deze bon en verdien zelf tot wel 500 euro!</p>
<a href="http://www.jongverzekerd.be/wp-content/uploads/2013/06/Doorverwijsbon.pdf"><img class="size-full wp-image-367 aligncenter" style="align: center;" alt="Jongverzekerd.be" src="http://www.jongverzekerd.be/wp-content/uploads/2013/06/knop_doorverwijsbon_jv.jpg" width="600" height="149" /></a>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">Met vriendelijke groeten,het Jongverzekerd-team.</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 10px; color: #000000;">De premie houdt rekening met totaalklant BOAR</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 10px; color: #000000;">Acceptatie en tarificatie onder voorwaarden</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 8px; color: #000000;">JONGVERZEKERD is een initiatief van:<br/>
Groep Alenus & Partners - Dorpstraat 19, 3560 Lummen - T: 013 521 005 - F: 013 521 353 - alenusenpartners@dvvlap.be - Ond. Nr. 0891.261.042<br/>
DVV Leuven-Hageland - Martelarenlaan 6B, 3010 Leuven - T: 016 223 975 - F: 016 239 910 - dvv.leuven.hageland@dvvlap.be - Ond. Nr. 0480.497.913<br/>
Tussenpersonen van DVV Verzekeringen. FSMA-nr: cA103028 - cA62389</p>
</div>';
stuur_email("noreply@jongverzekerd.be",$email,"Uw Scooter Premie",$bericht);
echo "<strong>Wij hebben uw premie verstuurd naar $email</strong>";
/****************************************************************************************************************/
//De gegevens van de gebruiker worden hier verstuurd
/****************************************************************************************************************/
//overige data
$verzendDatum = date('d-m-Y');
$ip = $_SERVER['REMOTE_ADDR'];
$beheerder ="hendrik_lievens@hotmail.com";
$bericht = 'Aanvraag verstuurd op :'.$verzendDatum.'<br/>
IP-adres gebruiker : '.$ip.'<br/>
Aanvraag : <br/>
<table width="99%" border="0" cellpadding="1" cellspacing="0" bgcolor="#EAEAEA">
<tr>
<td>
<table width="100%" border="0" cellpadding="5" cellspacing="0" bgcolor="#FFFFFF">
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Naam en Voornaam</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$naam.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Geboortedatum</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$datum.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Postcode</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$postcode.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>E-mailadres</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$email.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Tel of GSM</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$tel.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Laatset 5 jaar ongeval gehad</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$ongeval.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Burgerlijke Status</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$status.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Momenteel verzekerd bij</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$maatschappij.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Scootermerk</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$merk.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Cilinderinhoud</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$cc.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Voorgestelde Premie</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;"><strong> €'.$premie.'</strong></font></td>
</tr>
</table>
</td>
</tr>
</table>';
stuur_email("noreply@jongverzekerd.be",$beheerder,"[SCOOTER] Premie van $naam",$bericht);
/****************************************************************************************************************/
}
}
print_r($_SESSION);
?>
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
- Output for 5.3.0 - 5.3.29, 7.2.29 - 7.2.33, 7.3.12 - 7.3.31, 7.4.0 - 7.4.25, 7.4.27 - 7.4.32, 8.0.0 - 8.0.12, 8.0.14 - 8.0.30, 8.1.0 - 8.1.27, 8.2.0 - 8.2.17, 8.3.0 - 8.3.4
- <h2>Scooter Premie Berekenen</h2>
[insert_php]
<?
session_start();
ini_set('display_errors', true);
error_reporting(E_ALL);
//Dit is een functie die de data trimt , slashes verwijdert en speciale karakters converteert.
function parse($data,$key)
{
$data = trim($data);
$data = stripslashes($data);
$data = htmlspecialchars($data);
$_SESSION[$key]=$data;
return $data;
}
//Dit is een functie die kijkt of een geldige datum is ingevoerd
function parse_datum($datum)
{
$dag = substr($datum,0,2);
$maand = substr($datum,3,2);
$jaar = substr($datum,6,4);
if(checkdate($maand, $dag, $jaar)==1)
{ return true; }
else
{ return false; }
}
//Dit is een functie die een fout print naar de gebruiker
function print_error($error)
{
echo "<span style='color: red; '>$error</span>";
}
//Dit is een functie die de leeftijd van de gebruiker berekent
function leeftijd($datum)
{
return floor((time() - strtotime($datum))/31556926);
}
//Dit is een functie die een premie berekent
function bereken_premie($leeftijd,$cc,$status)
{
$premie = 0;
if($status=="inwonend")
{
$leeftijd = 30;
}
if($leeftijd<26)
{
if($cc==125) $premie = 198.44;
else if($cc==250) $premie = 262.07;
else if($cc==300) $premie = 287.46;
else if($cc==400) $premie = 338.33;
else if($cc==500) $premie = 389.17;
}
else if($leeftijd>=26 && $leeftijd<=29)
{
if($cc==125) $premie = 166.68;
else if($cc==250) $premie = 219.93;
else if($cc==300) $premie = 241.02;
else if($cc==400) $premie = 283.41;
else if($cc==500) $premie = 325.77;
}
else if($leeftijd>29)
{
if($cc==125) $premie = 103.64;
else if($cc==250) $premie = 135.39;
else if($cc==300) $premie = 148.12;
else if($cc==400) $premie = 173.55;
else if($cc==500) $premie = 198.96;
}
return $premie;
}
//Dit is een functie die een email stuurt
function stuur_email($van,$naar,$onderwerp,$bericht)
{
$headers = "From: $van \r\n";
$headers .= "Reply-To: $van \r\n";
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-Type: text/html; charset=ISO-8859-1\r\n";
mail($naar,$onderwerp,$bericht,$headers);
}
$naamError = $datumError = $postcodeError = $emailError = $telError = $merkError = "";
$naam = $datum = $postcode = $email = $tel = $merk = $cc ="";
if(!empty($_SESSION['naam']))
$naam = $_SESSION['naam'];
if(!empty($_SESSION['datum']))
$datum = $_SESSION['datum'];
if(!empty($_SESSION['postcode']))
$postcode = $_SESSION['postcode'];
if(!empty($_SESSION['email']))
$email = $_SESSION['email'];
if(!empty($_SESSION['tel']))
$tel = $_SESSION['tel'];
$ongeval ="nee";
$maatschappij = "Nog geen verzekering";
if ($_SERVER["REQUEST_METHOD"] == "POST")
{
if(empty($_POST['naam']))
{ $naamError = "Naam is een verplicht veld"; }
else
{ $naam = parse($_POST['naam'],"naam"); }
if(empty($_POST['datum']))
{
$datumError = "Geboortedatum is een verplicht veld";
}
else
{
$datum = $_POST['datum'];
if(!parse_datum($datum))
$datumError = "De opgegeven geboortedatum is ongeldig";
}
if(empty($_POST['postcode']))
{ $postcodeError = "Postcode is een verplicht veld"; }
else
{ $postcode = parse($_POST['postcode'],"postcode"); }
if(empty($_POST['email']))
{ $emailError = "Email is een verplicht veld"; }
else
{ $email = parse($_POST['email'],"email"); }
if(empty($_POST['tel']))
{ $telError = "Telefoon is een verplicht veld"; }
else
{ $tel = parse($_POST['tel'],"tel"); }
if(empty($_POST['ongeval']))
{ $ongeval = "nee"; }
else
{ $ongeval = "ja";}
$status = $_POST['status'];
if(empty($_POST['maatschappij']))
{ $maatschappij = "Nog geen verzekering"; }
else
{ $maatschappij = parse($_POST['maatschappij']); }
if(empty($_POST['merk']))
{ $merkError = "Merk is een verplicht veld"; }
else
{ $merk = parse($_POST['merk'],"merk"); }
$cc = $_POST['cc'];
//Als er zich geen fouten voordoen , berekenen we de premie.
if($naamError=="" && $datumError=="" && $postcodeError=="" && $emailError=="" && $telError=="" && $merkError=="")
{
$leeftijd = leeftijd($datum); //bereken de leeftijd aan de hand van de geboortedatum
if($ongeval=="ja")
$premie = 0;
else
$premie = bereken_premie($leeftijd,$cc,$status); //bereken de premie
//De premie is berekent, we sturen de gebruiker een email met zijn premie voorstel, dit is het bericht dat we hem sturen
/****************************************************************************************************************/
$bericht = '<div align="center">
<img class="size-full wp-image-367 aligncenter" style="align: center;" alt="Jongverzekerd.be" src="http://jongverzekerdbe.webhosting.be/wp-content/uploads/2013/02/mail_top.png" width="600" height="149" />
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">Beste <strong>'.$naam.'</strong>,</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">U heeft een premieberekening gedaan op onze website. In deze e-mail vindt u het resultaat</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;"><strong>';
if($premie==0)
{
$bericht.="U heeft de afgelopen 5 jaar een ongeval gehad. Dit betekent dat wij u geen premie kunnen aanbieden. Onze excuses</strong></p>";
}
else
{
$bericht.="€ $premie *</strong></p>";
}
$bericht.=' <hr>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;"><strong>Uniek: verdien tot 500 euro per jaar!</strong></p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">U hebt vast en zeker nog wel kenissen die ook te veel betalen voor hun verzekering. Maak ze nu klant met deze bon en verdien zelf tot wel 500 euro!</p>
<a href="http://www.jongverzekerd.be/wp-content/uploads/2013/06/Doorverwijsbon.pdf"><img class="size-full wp-image-367 aligncenter" style="align: center;" alt="Jongverzekerd.be" src="http://www.jongverzekerd.be/wp-content/uploads/2013/06/knop_doorverwijsbon_jv.jpg" width="600" height="149" /></a>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 12px; color: #000000;">Met vriendelijke groeten,het Jongverzekerd-team.</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 10px; color: #000000;">De premie houdt rekening met totaalklant BOAR</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 10px; color: #000000;">Acceptatie en tarificatie onder voorwaarden</p>
<p style="text-align: center; font-family: Arial, Helvetica, sans-serif; font-size: 8px; color: #000000;">JONGVERZEKERD is een initiatief van:<br/>
Groep Alenus & Partners - Dorpstraat 19, 3560 Lummen - T: 013 521 005 - F: 013 521 353 - alenusenpartners@dvvlap.be - Ond. Nr. 0891.261.042<br/>
DVV Leuven-Hageland - Martelarenlaan 6B, 3010 Leuven - T: 016 223 975 - F: 016 239 910 - dvv.leuven.hageland@dvvlap.be - Ond. Nr. 0480.497.913<br/>
Tussenpersonen van DVV Verzekeringen. FSMA-nr: cA103028 - cA62389</p>
</div>';
stuur_email("noreply@jongverzekerd.be",$email,"Uw Scooter Premie",$bericht);
echo "<strong>Wij hebben uw premie verstuurd naar $email</strong>";
/****************************************************************************************************************/
//De gegevens van de gebruiker worden hier verstuurd
/****************************************************************************************************************/
//overige data
$verzendDatum = date('d-m-Y');
$ip = $_SERVER['REMOTE_ADDR'];
$beheerder ="hendrik_lievens@hotmail.com";
$bericht = 'Aanvraag verstuurd op :'.$verzendDatum.'<br/>
IP-adres gebruiker : '.$ip.'<br/>
Aanvraag : <br/>
<table width="99%" border="0" cellpadding="1" cellspacing="0" bgcolor="#EAEAEA">
<tr>
<td>
<table width="100%" border="0" cellpadding="5" cellspacing="0" bgcolor="#FFFFFF">
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Naam en Voornaam</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$naam.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Geboortedatum</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$datum.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Postcode</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$postcode.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>E-mailadres</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$email.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Tel of GSM</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$tel.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Laatset 5 jaar ongeval gehad</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$ongeval.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Burgerlijke Status</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$status.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Momenteel verzekerd bij</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$maatschappij.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Scootermerk</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$merk.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Cilinderinhoud</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;">'.$cc.'</font></td>
</tr>
<tr bgcolor="#FE9000">
<td colspan="2"><font style="font-family: sans-serif; font-size:12px;"><strong>Voorgestelde Premie</strong></font></td>
</tr>
<tr bgcolor="#FFFFFF">
<td width="20"> </td>
<td><font style="font-family: sans-serif; font-size:12px;"><strong> €'.$premie.'</strong></font></td>
</tr>
</table>
</td>
</tr>
</table>';
stuur_email("noreply@jongverzekerd.be",$beheerder,"[SCOOTER] Premie van $naam",$bericht);
/****************************************************************************************************************/
}
}
print_r($_SESSION);
?>
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
- Output for 8.0.13
- <h2>Scooter Premie Berekenen</h2>
[insert_php]
Warning: session_start(): Session cannot be started after headers have already been sent in /in/a21dW on line 4
Warning: Undefined array key "REQUEST_METHOD" in /in/a21dW on line 97
Warning: Undefined variable $_SESSION in /in/a21dW on line 287
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
- Output for 7.2.0 - 7.2.13, 7.3.0 - 7.3.1, 7.3.32 - 7.3.33, 7.4.26, 7.4.33
- <h2>Scooter Premie Berekenen</h2>
[insert_php]
Warning: session_start(): Cannot start session when headers already sent in /in/a21dW on line 4
Notice: Undefined index: REQUEST_METHOD in /in/a21dW on line 97
Notice: Undefined variable: _SESSION in /in/a21dW on line 287
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
- Output for 7.0.18 - 7.0.31, 7.1.4 - 7.1.25
- <h2>Scooter Premie Berekenen</h2>
[insert_php]
Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /in/a21dW:1) in /in/a21dW on line 4
Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /in/a21dW:1) in /in/a21dW on line 4
Notice: Undefined index: REQUEST_METHOD in /in/a21dW on line 97
Array
(
)
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
- Output for 5.4.0 - 5.4.45, 5.5.0 - 5.5.38, 5.6.0 - 5.6.38, 7.0.0 - 7.0.17, 7.1.0 - 7.1.3
- <h2>Scooter Premie Berekenen</h2>
[insert_php]
Warning: session_start(): Cannot send session cookie - headers already sent by (output started at /in/a21dW:3) in /in/a21dW on line 4
Warning: session_start(): Cannot send session cache limiter - headers already sent (output started at /in/a21dW:3) in /in/a21dW on line 4
Notice: Undefined index: REQUEST_METHOD in /in/a21dW on line 97
Array
(
)
[/insert_php]
<form action="http://www.jongverzekerd.be/scooter" method="POST">
[insert_php]print_error($naamError); [/insert_php]
[one_half]<strong>Naam en Voornaam:*</strong>[/one_half][one_half_last]<input type="text" name="naam" size="40" value="[insert_php] echo $naam; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($datumError); [/insert_php]
[one_half]<strong>Geboortedatum:*</strong>[/one_half][one_half_last]<input type="text" name="datum" placeholder="dd-mm-jjjj" value="[insert_php] echo $datum; [/insert_php]" size="40" />
Formaat dd-mm-jjjj : <em>15-03-1979</em>[/one_half_last]
[insert_php]print_error($postcodeError); [/insert_php]
[one_half]<strong>Postcode:*</strong>[/one_half][one_half_last]<input type="text" name="postcode" size="40" value="[insert_php] echo $postcode; [/insert_php]" />[/one_half_last]
[insert_php]print_error($emailError); [/insert_php]
[one_half]<strong>E-mailadres:*</strong>[/one_half][one_half_last]<em>Uw premieberekening wordt per mail verstuurd,dit adres dient correct te zijn.</em>
<input type="email" name="email" size="40" value="[insert_php] echo $email; [/insert_php]"/>[/one_half_last]
[insert_php]print_error($telError); [/insert_php]
[one_half]<strong>Tel of GSM:*</strong>[/one_half][one_half_last]<input type="text" name="tel" placeholder="012 34 56 78" size="40" value="[insert_php] echo $tel; [/insert_php]"/>[/one_half_last]
[one_half]<strong>Laatste 5 jaar ongeval gehad:*</strong>[/one_half]
[one_half_last]
<input type="checkbox" name="ongeval" value="ja" [insert_php] if($ongeval=="ja") echo 'checked="checked"'; [/insert_php]/>
[/one_half_last]
[one_half]<strong>Burgerlijke Status:*</strong>[/one_half]
[one_half_last]
<select name="status">
<option value="inwonend" [insert_php] if($status=="inwonend") echo 'selected="selected"';[/insert_php]>inwonende jonge bestuurder</option>
<option value="alleenstaand" [insert_php] if($status=="alleenstaand") echo 'selected="selected"';[/insert_php]>alleenstaand</option>
<option value="samenwonend" [insert_php] if($status=="samenwonend") echo 'selected="selected"';[/insert_php]>samenwonend</option>
<option value="gehuwd" [insert_php] if($status=="gehuwd") echo 'selected="selected"';[/insert_php]>gehuwd</option>
</select>
[/one_half_last]
[one_half]<strong>Ik ben verzekerd bij:*</strong>[/one_half][one_half_last]<input type="text" name="maatschappij" size="40" value="[insert_php] echo $maatschappij; [/insert_php]" />[/one_half_last]
[insert_php]print_error($merkError); [/insert_php]
[one_half]<strong>Scootermerk:*</strong>[/one_half][one_half_last]<input type="text" name="merk" size="40" value="[insert_php] echo $merk; [/insert_php]" />[/one_half_last]
[one_half]<strong>Cilinderinhoud:*</strong>[/one_half]
[one_half_last]
<select name="cc">
<option value="125" [insert_php] if($cc=="125") echo 'selected="selected"';[/insert_php]>125</option>
<option value="250" [insert_php] if($cc=="250") echo 'selected="selected"';[/insert_php]>250</option>
<option value="300" [insert_php] if($cc=="300") echo 'selected="selected"';[/insert_php]>300</option>
<option value="400" [insert_php] if($cc=="400") echo 'selected="selected"';[/insert_php]>400</option>
<option value="500" [insert_php] if($cc=="500") echo 'selected="selected"';[/insert_php]>500+</option>
</select>
[/one_half_last]
<center><input type="submit" value="Bereken mijn premie" /></center></form>
preferences:
276.01 ms | 410 KiB | 365 Q