Sick and Condolence

"; $subject.="

Your Sick or Condolence notification has been sent.

"; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=""; $subject.=" "; $subject.=" "; $subject.=" "; $subject.=" "; $subject.="

"; $subject.=" Name of the Sick Individual	" . $_POST['sick'] . "
"; $subject.=" Full Name of the Deceased Individual	" . $_POST['deceased'] . "
"; $subject.=" Submitter's Information
"; $subject.=" Sender's Name	" . $_POST['sender'] . "
Address	" . $_POST['senderaddress'] . "
City	" . $_POST['senderscity'] . "
State	" . $_POST['sendersstate'] . "
Zip	" . $_POST['senderszip'] . "
Phone	" . $_POST['senderphone'] . "
E-mail Address	" . $_POST['senderemail'] . "
Special Instructions:	" . $_POST['instructions'] . "

"; $subject.=" "; $headers = 'MIME-Version: 1.0' . "\r\n"; $headers .= 'Content-type: text/html; charset=iso-8859-1' . "\r\n"; mail('carlosmvaldezlv@gmail.com', 'Email From Barrett Assembly Website', $subject, $headers);} } } else { ?>

Please Email us with your Sick or Condolence Notification.

Please include the following information.

Name of Sick Individual

Full Name of the Deceased Individual

Submitter's Information is Required

Name

Address

City

State

Zip

Phone

Email Address