I need Script Php

[Lock Down]

Create the form and show your code here.

[softpk]

Create the form and show your code here.

My Form Code:

    <div class="toggle_container">
                        <div class="block">
                            <form>
                                <center><b><h7>Vendor Service Request</h7></b></center>
                                
                                <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label class="hospitalname">Hospital Name</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Ref No.</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                                
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>From</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Description</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                      
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>Designation</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Manufacture</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                      
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>Tel Number</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Models</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                      
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>Mobile Number</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Serial numbers</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                                
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>Fax</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Equipment</label>
                                            <div>
                                            
                                                <input type="text" class="long">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                      
                                 <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                            <label>Email address</label>
                                            <div>
                                                <input type="text" class="long">
                                            </div>
                                        </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label class="attachment">Attachement</label>
                                            <div>
                                            
                                                <input type="file" id="fileupload2" class="uniform">
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                                
                                <div class="columns clearfix">
                                    
                                    <div class="col_50">
                                        <fieldset>
                                    
                                    <label>Type</label>
                                    <div class="uniform">
                                        <label for="yes">
                                            <input type="checkbox" name="yes" id="yes"/>
                                            Warranty
                                        </label>
                                        <label for="no">
                                            <input type="checkbox" name="no" id="no"/>
                                            PPM Contact
                                        </label>
                                        <label for="cant">
                                            <input type="checkbox" name="no" id="no"/>
                                            Repair argent
                                        </label>
                                    
                                </fieldset>
                                    </div>
                                    
                                    <div class="col_50">
                                    
                                        <fieldset>
                                            
                                            <label>Fault Description And Service Description</label>
                                            <div>
                                            
                                                <textarea name="textarea" height="50px" class="long"></textarea>
                                            
                                            </div>
                                            
                                        </fieldset>
                                    
                                    </div>
                                    
                                </div>
                                
                                                   
                                <div class="padding_10">                                    
                                    
                                    <button type="submit" class="button blue"> <img src="images/icons/white/png/checkmark_icon&16.png" /> Submit </button>
                                    <button type="reset" class="button green"> <img src="images/icons/white/png/brush_icon&16.png" /> Preview </button>
                                    
                                    <div class="clear"></div><!-- CLEAR BOTH -->
                                    
                                </div>

                            </form>
                            
                        </div>
                        
                    </div>
                    
                </div> 

[Lock Down]

Lock Down I need more help i am making a request form. After the data submit will be save in database and when the record and 1 id click on the full preview record


see my request form:



and like this display record:




Please help me

The form you posted looks nothing like the one above. Fix it.
Now why do you have a submit and preview button on the form if the the preview comes up when you hit the id.
I am guessing you have the submit in case you want to make changes to the displayed record??

And why is there a view record in the listing if you are clicking id to display record????

Also for database purposes which of the hospital information will be unique? Reference number??

Explain these and fix the form ..

[softpk]

Actually I am making a request form. My client request this form is for every visitor. visitor send request and submit form then goto request inbox in admin panel.

This is the kind of form ticket system. I can not submit and display attachment file and checkbox in db. please you make me an example form

Form:
Hospital | Attachment File | Checkbox


Submit form and goto request inbox

like this:



then click CoffeeCup Team To Full View:

[Lock Down]

Now I am confused.

You want the form to be displayed.

Then fields are filled out and they click submit.

You then want what?? An email sent to admin? Or a new database record created??

Or both or what??

[JamesVaporH]

At first i thought he was trying to say

1. wanted a form to submit the records
2. A page shows all records (view record link would open step 3)
3. a single php file that pulls the record id and shows all info submited into the database

Now that hotmail picture threw me off hahah

edit: or maybe he wants a confirmation email link setup?

[softpk]

i am making display db record but show this error please solved this problem

Parse error: syntax error, unexpected T_STRING, expecting ',' or ';' in  G:\WampDeveloper\Websites\DefaultWebsite\webroot\database\index.php on  line 105 

My Code:

<div class="mws-panel grid_8">
                    <div class="mws-panel-header">
                        <span class="mws-i-24 i-table-1">Simple Table</span>
                    </div>
                    <div class="mws-panel-body">
                        <table class="mws-table">
                         <thead>
                                <tr>
                                    <th>Full Detail</th>
                                    <th>Hospital Name</th>
                                    <th>Service Report</th>
                                    <th>Date</th>
                                </tr>
                            </thead>
                            <tbody>
                           
                            
 <?php
        $con = mysql_connect("localhost","username","password");
        if (!$con)
          {
          die('Could not connect to database');
          }
        
        mysql_select_db("my_db", $con);
        
        $keywords = $_POST['key_words'];
        
        $sql = "SELECT id, servicereport, hospitalname
                FROM insrep
                WHERE servicereport LIKE '%$keywords%'
                OR hospitalname LIKE '%$keywords%'
                ORDER BY servicereport";
        
        $rst = mysql_query($sql, $con);
        
         echo "<tr class='gradeX'>";
        
        while($a_row = mysql_fetch_assoc($rst)) {
            echo "<td><a href='player.php?id={$a_row['id']}'>"Full Detail Vendor Service Request"</td>";
            echo "<td>" . $row->hostpitalname . "</td>";
            echo "<td>" . $row->servicereport . "</td>";
            echo "<td>" . $row->Date . "</td>";
            echo "</tr>";
            
            
            

        }
        
        mysql_close($con); //close the connection to the database
    ?>
    
     
                            </tbody>
                        </table>
                    </div>
                </div>

[JamesVaporH]

these

            echo "<td>" . $row->hostpitalname . "</td>";
            echo "<td>" . $row->servicereport . "</td>";
            echo "<td>" . $row->Date . "</td>";

change to

            echo "<td>"' . $row->hostpitalname . '"</td>";
            echo "<td>"' . $row->servicereport . '"</td>";
            echo "<td>"' . $row->Date . '"</td>";

[softpk]

This error is still coming

Parse error: syntax error, unexpected T_STRING, expecting ',' or ';' in G:\WampDeveloper\Websites\DefaultWebsite\webroot\d atabase\index.php on line 105

[JamesVaporH]

Is the code above line 105 of index.php?