Auto Insurance Form
Applicants Name : '.$uname.' Previous Address: (if less than 3 years)
Current Address : '.$add1.'   '.$add2.' '.$padd1.'   '.$padd2.'
City : '.$city.' City : '.$pcity.'
State : '.$state.' State : '.$pstate.'
Zip Code: '.$zip.' Zip Code: '.$pzip.'
Country : '.$country.' Country : '.$pcountry.'
Time in Residency: '.$time.'    
TelePhone Number: '.$phone.'
No. of Vehicle '.$vehicle.'
'; for($i=1;$i<=$vehicle;$i++) { //echo $_REQUEST['textvehiclemake00'.$i]; $message=$message . ''; } '
Vehicle Make Vehicle Model Year Vehicle Type vin#
'.$vehiclemake.' '.$vehiclemodel.' '.$year.' '.$vehicletype.' '.$vehiclemodel.'
'.$_REQUEST['textvehiclemake00'.$i].' '.$_REQUEST['textvahiclemodel00'.$i].' '.$_REQUEST['textyear00'.$i].' '.$_REQUEST['textvahicletype00'.$i].' '.$_REQUEST['textvahiclemodel00'.$i].'

 

 
     
'; $to = 'info@insuranceindustriesinc.com'; $subject = "Auto Insurance Form"; $from = $uname; /* To send HTML mail, you can set the Content-type header. */ $headers = "MIME-Version: 1.0\r\n"; $headers .= "Content-type: text/html; charset=iso-8859-1\r\n"; $headers .= "Cc: amit@dediss.com\r\n"; $headers .= "From: ".$from."\r\n"; mail($to, $subject, $message, $headers); //echo $message; /////-----------------end of mail---------------------// header("location:thankyou.html"); die(); } //////////////////////////////////Function For Send mail////////////////////////////////////// function SendEmail($to,$from,$subject,$msg,$cond) { //$cond=0 For the simple mail to send //$cond=1 For Html Format Mail Send if($cond==0) { $mail_subject = $subject; $message = $msg; $mail_to = $to; $mail_from = $from; $headers = "From:".$mail_from; return mail($mail_to, $mail_subject, $message, $headers); } if($cond==1) { $message = $msg; /* To send HTML mail, you can set the Content-type header. */ $headers = "MIME-Version: 1.0\r\n"; $headers .= "Content-type: text/html; charset=iso-8859-1\r\n"; /* additional headers */ $headers .= "To: ".$to."\r\n"; $headers .= "From: ".$from."\r\n"; /* and now mail it */ return mail($to, $subject, $message, $headers); } } /////////////////////////////////////////////////////////////////////////////////////////////// ?> Insurance Industries
 
 
 
          
 
 
 
 
 
Auto Insurance
 

We are committed to your complete satisfaction. At Insurance Industries we believe there's more to auto insurance than coverages and claims. And if you do need to make a claim, we'll handle it as quickly, professionally and gently as we can. Our job? To give you the benefits of our experience. More than 20 years of it, grounded in the automotive industry. Insurance Industries takes pride in the products and services we offer, designed to give you the best possible auto insurance coverage – affordably – from your first car to your 21st.We don't just want to “get” your business. We want to keep it.

 
 
 
 
 
 
Auto Insurance Form
* Applicant's Name : Previous Address: (if less than 3 years)
* Current Address :  
   
* City : City :
* State : State :
* Zip Code: Zip Code:
* Country : Country :
* Time in Residency:
* Telephone Number:
* No. of Vehicle:
* Vehicle Make: * Vehicle Model: * Year: * Vehicle Type: * Vin #:
 

 

 
 
 
 
 
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Copyright © 2005-2007 insuranceindustries.com. All rights reserved.
 
 
 
Company Highlights  
 
   
Honesty:
  We are honest with our customers, our partners, our owners, and ourselves.
Dedication:
  We are dedicated to continually improving our products, our operations, and our customers’ satisfaction.
Satisfaction
  We value our customers and are deeply committed to safeguarding their information.
 
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