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User: nationalmedicaregrp (1119)
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File: /home/accuhealthinsuranceadvisors/public_html/process.php
<?php
// Configure your Subject Prefix and Recipient here
$subjectPrefix = 'NEW WEBSITE LEAD!';
$emailTo       = '[email protected]';
$errors = array(); // array to hold validation errors
$data   = array(); // array to pass back data
if($_SERVER['REQUEST_METHOD'] === 'POST') {
    $name    = stripslashes(trim($_POST['name']));
    $zip    = stripslashes(trim($_POST['zip']));
    $email   = stripslashes(trim($_POST['email']));
    $phone = stripslashes(trim($_POST['phone']));
    $plan = stripslashes(trim($_POST['plan']));
    $members    = stripslashes(trim($_POST['members']));
    $message    = stripslashes(trim($_POST['message']));
    if (empty($name)) {
        $errors['name'] = 'Name is required.';
    }
    if (empty($zip)) {
        $errors['zip'] = 'Zip is required.';
    }
    if (!filter_var($email, FILTER_VALIDATE_EMAIL)) {
        $errors['email'] = 'Email Address is invalid.';
    }
    if (empty($phone)) {
        $errors['phone'] = 'Phone number is required.';
    }
    if (empty($plan)) {
        $errors['plan'] = 'Plan Type is required.';
    }
    // if there are any errors in our errors array, return a success boolean or false
    if (!empty($errors)) {
        $data['success'] = false;
        $data['errors']  = $errors;
    } else {
        $subject = "$subjectPrefix";
        $body    = '
            <strong>Name: </strong>'.$name.'<br />
            <strong>Zip: </strong>'.$zip.'<br />
            <strong>Email: </strong>'.$email.'<br />
            <strong>Phone: </strong>'.$phone.'<br />
            <strong>Plan Type: </strong>'.$plan.' <br />
            <strong>Members: </strong>'.$members.' <br />
            <strong>Message: </strong>'.nl2br($message).'<br />
        ';
        $headers  = "MIME-Version: 1.1" . PHP_EOL;
        $headers .= "Content-type: text/html; charset=utf-8" . PHP_EOL;
        $headers .= "Content-Transfer-Encoding: 8bit" . PHP_EOL;
        $headers .= "Date: " . date('r', $_SERVER['REQUEST_TIME']) . PHP_EOL;
        $headers .= "Message-ID: <" . $_SERVER['REQUEST_TIME'] . md5($_SERVER['REQUEST_TIME']) . '@' . $_SERVER['SERVER_NAME'] . '>' . PHP_EOL;
        $headers .= "From: " . "=?UTF-8?B?".base64_encode($name)."?=" . "<$email>" . PHP_EOL;
        $headers .= "Return-Path: $emailTo" . PHP_EOL;
        $headers .= "Reply-To: $email" . PHP_EOL;
        $headers .= "X-Mailer: PHP/". phpversion() . PHP_EOL;
        $headers .= "X-Originating-IP: " . $_SERVER['SERVER_ADDR'] . PHP_EOL;
        mail($emailTo, "=?utf-8?B?" . base64_encode($subject) . "?=", $body, $headers);
        $data['success'] = true;
        $data['message'] = 'Success! Your licensed agent will be calling you shortly.';
    }
    // return all our data to an AJAX call
    echo json_encode($data);
}