<form method="post" action="the url to the script here" enctype="multipart/form-data">
<select name="title">
<option value="mr">Mr</option>
<option value="mrs">Mrs</option>
<option value="miss">Miss</option>
<option value="ms">Ms</option>
<option value="other">Other</option>
</select><br><br>
First name: <br>
<input type="text" name="firstname">
<br><br>
Last name:<br>
<input type="text" name="lastname">
<br><br>
Email address:<br>
<input type="text" name="email">
<br><br>
Phone number:<br>
<input type="text" name="phone">
<br><br>
What suburb are you in?
<br>
<input name="suburb" type="text" />
<br><br>
What kind of work would you like to request a quote for?
<br>
<select name="work">
<option value="brick">Brick Work</option>
<option value="block">Block Work</option>
<option value="paving">Paving</option>
<option value="concrete">Concrete Pumping</option>
<option value="grout">Grout Pumping</option>
<option value="other">Other</option>
</select>
<br><br>
Please give an idea of the work to be done?
<textarea name="work2bdone" rows="15" cols="40">
  </textarea>
<br><br>
What is the best day for us to contact you ?<br>
(Tick all that apply)<br><br>

<input type="checkbox" name="day[]" value="Monday">
Monday<br>
<input type="checkbox" name="day[]" value="Tuesday">
Tuesday<br>
<input type="checkbox" name="day[]" value="Wednesday">
Wednesday<br>
<input type="checkbox" name="day[]" value="Thursday">
Thursday<br>
<input type="checkbox" name="day[]" value="Friday">
Friday<br>
<input type="checkbox" name="day[]" value="Saturday">
Saturday<br>
<input type="checkbox" name="day[]" value="Sunday">
Sunday
<br><br>
What time is best for us to contact you?<br>
(Tick all that apply)<br><br>
<input type="checkbox" name="time[]" value="8-12">
8am-12am<br>
<input type="checkbox" name="time[]" value="12-5">
12am-5pm<br>
<input type="checkbox" name="time[]" value="5-9">
5pm-9pm<br>
<input type="checkbox" name="time[]" value="Any">
Anytime
<br><br>
Where did you hear about us?<br>
<select name="find">
<option value="google">Google</option>
<option value="friend">Through a friend</option>
<option value="busref">Through another business</option>
<option value="locpaper">Local newspaper</option>
<option value="natpaper">National newspaper</option>
<option value="buscard">Our business card</option>
<option value="car_graphic">Vehicle advertising</option>
<option value="other">Other</option>
</select>
<br><br>
  <input type="submit"  name="submit" value="Request Quote">
</form>

<?php

$returnURL = 'http://www.example.com';                 // The url to send the user back to if something went wrong
$successURL = 'http://www.example.com/success.html';// The url to send the user to if all goes well

$Temail     = 'rakuli@oce.com';// Change it to anything you like -- is where the email will be sent to
$TemailBcc  = 'random2@example.com'; // If you want to copy anyone in on all emails sent from the form, add them here separated by commas
$Semail        = '"Solid Masonry - Online Contact Form" <%s>';

// If we didn't receive the correct input from the submit button, we'll send them away straight awa

if (isset($_POST['submit']))
{

    //header ('Location: ' . $returnURL);
    //exit();


// Set up an array of the elements to check and place in our message
// if you want the value to be mandatory, change the false to true -- don't change 4=>true though

$formInputs = array('title'         => array('Title', true, array('mr', 'mrs', 'miss', 'ms', 'other')),
                    'firstname'     => array('First Name', true),
                    'lastname'        => array('Last Name', true),
                    'email'            => array('Email Address', true, 3 => 'check_email'),
                    'phone'            => array('Phone Number', false, 3 => 'ctype_digit'),
                    'suburb'        => array('Suburb', false),
                    'work'            => array('Work Type Request', false, array('brick', 'block', 'paving', 'concrete', 'grout', 'other')),
                    'work2bdone'    => array('Work To Be Performed', false),
                    'day'            => array('Best Day For Contact', false, array('Monday', 'Tuesday', 'Wednesday', 'Thursday', 'Friday', 'Saturday', 'Sunday'), 4 => true),
                    'time'            => array('Best Time For Contact', false, array('8-12', '12-5', '5-9', 'Any'), 4 => true),
                    'find'            => array('Where You Heard About Us', false, array('google', 'friend', 'busref', 'locpaper', 'natpaper', 'buscard', 'car_graphic', 'other'))
                    );


// now loop throught that new array and sort everything out

$errors         = array(); // Here is our errors list -- we will fill it as required
$errorMsg        = 'Please check that you entered <strong>%s</strong> correctly';

$messageArray    = array(); // Will hold the list of values to send out in the email
foreach ($formInputs as $pk => $pa)
{
    if (!isset($_POST[$pk]) && $pa[1] === true)
    {echo 'die ' . $_POST[$pk];
        $errors[] = sprintf($errorMsg, $pa[0]);
        continue;
    }
    


/***** Form inputs that have multiple available selections *****/
    if ($pa[4] === true && is_array($_POST[$pk])) {
    
        $msg = '';
        foreach($_POST[$pk] as $val)
        {
            $msg .= in_array($val, $pa[2]) ? "\t\t" . htmlentities($val) . "<br />\n" : '';
        }
        
        if (!empty($msg))
            $messageArray[] = '<strong>' . $pa[0] . "</strong> : <br />\n\n<br />" . $msg;
        else if ($pa[1] === true)
            $errors[] = sprintf($errorMsg, $pa[0]);
        
        continue;
    } else if ($pa[1] === true && $pa[4] === true) {
        $errors[] = sprintf($errorMsg, $pa[0]);
        continue;
    }

/***** Form inputs that have a list of options to select from ******/

    if (isset($pa[2]))
    {

        if (in_array($_POST[$pk], $pa[2]))
        {
            $messageArray[] = '<strong>' . $pa[0] . '</strong> : ' . htmlentities($_POST[$pk]);
        } else if ($pa[1] === true)
            $errors[] = sprintf($errorMsg, $pa[0]);
        
        continue;
    }
    $_POST[$pk] = trim($_POST[$pk]);

    if (empty($_POST[$pk]) && $pa[1] === true)
    {
        $errors[] = sprintf($errorMsg, $pa[0]);
        continue;
    } else if (empty($_POST[$pk]))
        continue;

/**** Form inputs that require some sort of validation (phone numbers/email) ****/

    if (isset($pa[3]))
    {
        if ($pa[3]($_POST[$pk]))
            $messageArray[] = '<strong>' . $pa[0] . '</strong> : ' . htmlentities($_POST[$pk]);
        else if ($pa[1] == true)
            $errors[] = sprintf($errorMsg, $pa[0]);
        
        continue;
    }
    
    // must be just a normal input so add it
    
    $messageArray[] = '<strong>' . $pa[0] . '</strong> : ' . htmlentities($_POST[$pk]);
    
}


// If we didn't have any errors occur we can start to set up the message

if (!count($errors))
{
    $Semail = sprintf($Semail, $_POST['email']);

   $ob = md5(time() . 'masonboundary');
   $ib = md5(time() . 'masonboundary2');
  
  
   $headers = "From: ".$Semail."\n";
   if (!empty($TemailBcc)) $headers .= "Bcc: ".$TemailBcc."\n";
   $headers .= "Reply-To: <". $_POST['email'].">\n";
   $headers .= "Return-Path: <" . $_POST['email'] . ">\n";
   $headers .= 'Date: ' . gmdate('D, d M Y H:i:s') . ' +0000' . "\n";
   $headers .= 'X-Mailer: Solid Masonry' . "\n";
  
   $headers .= 'Mime-Version: 1.0' . "\n";
   $headers .= 'Content-Type: multipart/alternative; boundary="' . $ob . '"' . "\n";
   $headers .= 'Content-Transfer-Encoding: 7bit' . "\n";
  
   $cnt = $content;
  
   $content = "<title>$Semail</title>\n\n\n";
   $content .= "<body style='font-family: verdana; font-size: 9pt;'>\n\n";
   $content .= "<h1 style='font-size:1.1em'>Someone Has Contacted you!</h1>\n\n\n";
  
// loop through the messages

foreach ($messageArray as $msg)
    $content .= $msg . "\n\n<br /><br />";  
  
   $content .= "Your Sincerely,\n\n<br /><br />";
   $content .= "Your Website";
  
  
   $message = strip_tags($content) . "\n" . '--' . $ob . "\n";
  
   $message .= 'Content-Type: text/plain; charset=iso-8859-1' . "\n";
   $message .= 'Content-Transfer-Encoding: 7bit' . "\n\n";
   $message .= strip_tags($content) . "\n" . '--' . $ob . "\n";
  
   $message .= 'Content-Type: text/html; charset=charset=iso-8859-1' . "\n";
   $message .= 'Content-Transfer-Encoding: 7bit' . "\n\n";
   $message .= $content . "\n" . '--' . $ob . '--';

  
   mail($Temail, $subject, $message, $headers);
   header('Location: ' . $successURL);
}

}
function check_email($email)
{  // First, we check that there's one @ symbol,
  // and that the lengths are right.
  if (!ereg("^[^@]{1,64}@[^@]{1,255}$", $email)) {
    // Email invalid because wrong number of characters
    // in one section or wrong number of @ symbols.
    return false;
  }
  // Split it into sections to make life easier
  $email_array = explode("@", $email);
  $local_array = explode(".", $email_array[0]);
  for ($i = 0; $i < sizeof($local_array); $i++) {
    if
(!ereg("^(([A-Za-z0-9!#$%&'*+/=?^_`{|}~-][A-Za-z0-9!#$%&
↪'*+/=?^_`{|}~\.-]{0,63})|(\"[^(\\|\")]{0,62}\"))$",
$local_array[$i])) {
      return false;
    }
  }
  // Check if domain is IP. If not,
  // it should be valid domain name
  if (!ereg("^\[?[0-9\.]+\]?$", $email_array[1])) {
    $domain_array = explode(".", $email_array[1]);
    if (sizeof($domain_array) < 2) {
        return false; // Not enough parts to domain
    }
    for ($i = 0; $i < sizeof($domain_array); $i++) {
      if
(!ereg("^(([A-Za-z0-9][A-Za-z0-9-]{0,61}[A-Za-z0-9])|
↪([A-Za-z0-9]+))$",
$domain_array[$i])) {
        return false;
      }
    }
  }
  return true;
}
?>                    

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
</head>

<body>
<?php

if (count($errors))
{
    echo '<div style="border: solid 1px red;padding: 2em;">
        <h1 style="font-size: 1.2em;">Some Errors Occurred</h1>
        <ul>';
    
    foreach ($errors as $err)
        echo '<li>', $err, '</li>';
        
        echo '</ul>
        <a href="', $returnURL , '" onclick="window.history.back(); return false;">Go Back and try again</a>
        </div>';
}
?>


</body>
</html>