MySQL Connect Failed : " . mysql_error()."

\n"); mysql_select_db($dbname,$dblink); $rmaddr = $_SERVER['REMOTE_ADDR']; $dob = $dob_day . '-' . $dob_month . '-' . $dob_year; $exp = $exp1."/".substr($exp2,2,2); $_SESSION['plan'] = $plan; $_SESSION['first_name'] = $first_name; $_SESSION['last_name'] = $last_name; $_SESSION['dob'] = $dob; $_SESSION['street'] = $street; $_SESSION['suburb'] = $suburb; $_SESSION['state'] = $state; $_SESSION['postcode'] = $postcode; $_SESSION['email_address'] = $email_address; $_SESSION['home'] = $home; $_SESSION['mobile'] = $mobile; $_SESSION['company'] = $company_name; $_SESSION['abn'] = $abn; $_SESSION['username'] = $username; $_SESSION['password'] = $password; $_SESSION['dl'] = $dl; //CC session $_SESSION['cctype'] = $cctype; $_SESSION['ccnum'] = $ccnum; $_SESSION['exp'] = $exp; $query = "INSERT INTO dialup_signup ( plan, name, dob, address, suburb, state, postcode, email, phone, mobile, biz_name, biz_abn, uname, pass, paytype, cc_no, cardname, cc_expire , ip_addr) values ( '$plan', '$first_name $last_name', '$dob', '$street', '$suburb', '$state', '$postcode', '$email_address', '$home', '$mobile', '$company', '$abn', '$username', '$password','$cctype', '$ccnum', '$first_name $last_name', '$exp', '$rmaddr' )"; // execute query $result = mysql_query($query,$dblink) or die("

Query Failed

\n"); $order_number = mysql_insert_id($dblink); // Email Provisioning // sent out email to customer about the signup $message = ""; $message = "New Dialup user submitted via webiste\n\nOrder Number: $order_number\nPlan: $plan\nName: $first_name $last_name\nDOB: $dob\nAddress: $street\nCity: $suburb\n"; $message = $message . "State: $state\nPostCode: $postcode\nPhone No: $home\nMobile No: $mobile\nEmail: $email_address\n"; $message = $message . "Business Name: $company\nBusiness ABN: $abn\nUsername: $username\nPassword: $password\nIP Address: $rmaddr"; $message = $message . "\n\nPlease login to retrieve customer payment details\n\nThank you."; if (!empty($email_address)) { $from = $email_address; } else { $from = 'iSage Signup '; } $to = 'iSage Provisioning '; $subject = 'Online Dialup Registration #' . $order_number; mail($to,$subject,$message,"From: " . $from); } } else { // if the form is only just being generated instead of a validation of customer input $verify = new verification_image; $verify->create_image(200,40,"verify.png"); $verify_string = $verify->verify_value; } include('../include/html_headers.php') ?>

Join iSage Dialup

Thank you for joining iSage Internet

A customer service representative will contact you within 24 hours to complete the registration process. If you are in a hurry, please don't hesitate to call our support line on 1300 725 789.

\n"; echo ""; echo "" ?>

Welcome to iSage Internet's secure online order form.

After completing this form an iSage representative will contact you within 24 hours to complete the registration. process. If you are in a hurry, please don't hesitate to call our support line on 1300 725 789.

"; echo "Errors:

$value

\n"; } ?>

iSage Dialup Plan Selection

Plan Name	Price
Standard Plan	$12.95 p/m	/>
Seniors Plan *	$6.35 p/m	/>

Enter Your Contact Infromation

Please enter in your contact information (* denotes required fields)

* First Name	"/>	* Last Name	"/>
Company	"/>	ABN	"/>
* Date of Birth		Driving License	"/>
* Street		* Suburb
* Postcode		* State
Home		Mobile
Email

Preferred Account Details

Please note that these details will be used to create your iSage Dialup Username and Email Address, this will be set to your contact email address if you have not supplied one.

* Username	"/>	@isage.net.au
* Password	"/>

Payment Details

Credit Card Type:	VISA	Mastercard
Credit Card Number:			Please use no symbols or spaces
Credit Card Expiry:		/

Image Verification

Please type in the text you see in the image. This is used for security purposes.


	" />

\n"; print "

By submitting this form you acknowledge that you have read and agree with the iSage Terms and Conditions.

\n"; print "

\n"; ?>