Phone Number : $phone
Content : $content
Address : $address"; // To send HTML mail, the Content-type header must be set // 관리자 $to = "pom@21insurance.com"; //$to = "chanyong.lee@gmail.com"; $eol="\r\n"; $headers .= "From: 한인종합보험 ".$eol; $headers .= "Reply-To: $business_name <$email>".$eol; $headers .= "Return-Path: $business_name <$email>".$eol; // these two to set reply address $headers .= "Message-ID: <".$now." TheSystem@".$_SERVER['SERVER_NAME'].">".$eol; $headers .= "X-Mailer: PHP v".phpversion().$eol; // These two to help avoid spam-filters $headers .= 'Content-type: text/html; charset=UTF-8' . "\r\n"; // Mail it $result = mail($to, $subject, $message, $headers); Misc::jvAlert("Your request has been successfully submitted. \\n\\n An agent will contact you within 24 hours. \\n\\nThank you.","location.replace('index.php')"); exit; } else { echo "Fail"; exit; } } include "inc_top.php"; ?>

 Business / Commercial
Please type a question mark(?) if you don't know the answer, and we will explain to you when we contact you.

 Legal Business Name * :  
 Doing Business As (DBA) :  
 Telephone Number * :  
 Email * :  
 Address * :  
 Type of Business * :  
 Size(s/f) :  
 Construction Type :   Brick Frame Non-combustible Masonry Fire-Resistive Other
 Number of Stories:  
 Gross Sales :  $
 Current Insurance Carrier :  
 Loss/Claim History in the last
 3 years :
  Yes No
 Sprinkler :   Yes No
 Burglar/Fire Alarm Type :   Central Station Alarm Local Alarm None
 Desired Content Limit
 (Business Personal Property) :
 $
 Desired Building Limit :  $
 Desired Liability Limit :  > $1,000,000 > $2,000,000 > Over $2,000,000
 Workers Compensation
 Insurance :
  I have I don't have
 Additional Information :