<?php
use PHPMailer\PHPMailer\PHPMailer;
use PHPMailer\PHPMailer\Exception;
require __DIR__.'/Exception.php';
require __DIR__.'/PHPMailer.php';
require __DIR__.'/SMTP.php';

function ValidateEmail($email)
{
   $pattern = '/^([0-9a-z]([-.\w]*[0-9a-z])*@(([0-9a-z])+([-\w]*[0-9a-z])*\.)+[a-z]{2,6})$/i';
   return preg_match($pattern, $email);
}
if ($_SERVER['REQUEST_METHOD'] == 'POST' && isset($_POST['formid']) && $_POST['formid'] == 'form2')
{
   $mailto = 'martijn.roos@true-care.nl';
   $mailfrom = isset($_POST['email']) ? $_POST['email'] : $mailto;
   $subject = 'Website form';
   $message = 'Values submitted from web site form:';
   $success_url = './succes(en).html';
   $error_url = './error(en).html';
   $autoresponder_from = 'ME@true-care.nl';
   $autoresponder_name = 'Truecare Medical Equipment';
   $autoresponder_to = isset($_POST['E-mail']) ? $_POST['E-mail'] : $mailfrom;
   $autoresponder_subject = 'Bevestiging aanvraag';
   $autoresponder_message = 'Dear Madam or Sir,

Thank for requesting a proposal. We will contact you within 2 working days.

Kind Regards,

Truecare Medical Equipment';
   $eol = "\n";
   $error = '';
   $internalfields = array ("submit", "reset", "send", "filesize", "formid", "captcha", "recaptcha_challenge_field", "recaptcha_response_field", "g-recaptcha-response", "h-captcha-response");

   $mail = new PHPMailer(true);
   try
   {
      $mail->IsSMTP();
      $mail->Host = 'smtp.strato.com';
      $mail->Port = 465;
      $mail->SMTPAuth = true;
      $mail->Username = 'martijn.roos@true-care.nl';
      $mail->Password = 'Kareltje12..';
      $mail->SMTPSecure = 'ssl';
      $mail->Subject = stripslashes($subject);
      $mail->From = $mailfrom;
      $mail->FromName = $mailfrom;
      $mailto_array = explode(",", $mailto);
      for ($i = 0; $i < count($mailto_array); $i++)
      {
         if(trim($mailto_array[$i]) != "")
         {
            $mail->AddAddress($mailto_array[$i], "");
         }
      }
      if (!ValidateEmail($mailfrom))
      {
         $error .= "The specified email address (" . $mailfrom . ") is invalid!\n<br>";
         throw new Exception($error);
      }
      $sender_domain = substr($mailfrom, strpos($mailfrom, '@') + 1);
      if (!checkdnsrr($sender_domain, "MX"))
      {
         if (!(checkdnsrr($sender_domain, "A")) or !(checkdnsrr($sender_domain, "AAAA")))
         {
            $error .= "No email can be sent to the specified domain (" . $sender_domain . ").\n<br>";
            throw new Exception($error);
         }
      }
      $mail->AddReplyTo($mailfrom);
      $message .= $eol;
      $message .= "IP Address : ";
      $message .= $_SERVER['REMOTE_ADDR'];
      $message .= $eol;
      foreach ($_POST as $key => $value)
      {
         if (!in_array(strtolower($key), $internalfields))
         {
            if (is_array($value))
            {
               $message .= ucwords(str_replace("_", " ", $key)) . " : " . implode(",", $value) . $eol;
            }
            else
            {
               $message .= ucwords(str_replace("_", " ", $key)) . " : " . $value . $eol;
            }
         }
      }
      $mail->CharSet = 'ISO-8859-1';
      if (!empty($_FILES))
      {
         foreach ($_FILES as $key => $value)
         {
            if ($_FILES[$key]['error'] == 0)
            {
               if (is_array($_FILES[$key]['name']))
               {
                  $count = count($_FILES[$key]['name']);
                  for ($file = 0; $file < $count; $file++)
                  {
                     $mail->AddAttachment($_FILES[$key]['tmp_name'][$file], $_FILES[$key]['name'][$file]);
                  }
               }
               else
               {
                  $mail->AddAttachment($_FILES[$key]['tmp_name'], $_FILES[$key]['name']);
               }
            }
         }
      }
      $mail->WordWrap = 80;
      $mail->Body = $message;
      $mail->Send();
      if (!ValidateEmail($autoresponder_from))
      {
         $error .= "The specified autoresponder email address (" . $autoresponder_from . ") is invalid!\n<br>";
         throw new Exception($error);
      }

      $mail->ClearAddresses();
      $mail->ClearAttachments();
      $mail->Subject = stripslashes($autoresponder_subject);
      $mail->From = $autoresponder_from;
      $mail->FromName = $autoresponder_name;
      $mail->AddAddress($autoresponder_to, "");
      $mail->AddReplyTo($autoresponder_from);
      $mail->IsHTML(false);
      $mail->WordWrap = 80;
      $mail->Body = $autoresponder_message;
      $mail->Send();
      header('Location: '.$success_url);
   }
   catch (Exception $e)
   {
      $errorcode = file_get_contents($error_url);
      $replace = "##error##";
      $errorcode = str_replace($replace, $e->getMessage(), $errorcode);
      echo $errorcode;
   }
   exit;
}
?>
<!doctype html>
<html>
<head>
<meta charset="utf-8">
<title>Webform equipment list</title>
<meta name="description" content="Truecare is een adviesbureau gespecialiseerd in de optimalisatie van zorgsystemen">
<meta name="keywords" content="Truecare DRG Health System Performance Beacons Beacon technology Healthcare Gezondheidszorg PwC Aruba Antillen Bekostiging Besturing Optimization">
<meta name="author" content="Truecare Nederland">
<meta name="generator" content="WYSIWYG Web Builder 11 - http://www.wysiwygwebbuilder.com">
<link href="favicon.ico" rel="shortcut icon" type="image/x-icon">
<link href="Truecare_website_source.css" rel="stylesheet">
<link href="webform2(en).css" rel="stylesheet">
<script src="jquery-1.12.4.min.js"></script>
<script src="wb.validation.min.js"></script>
<script>
function submitEquipment_list_(NL)()
{
   var regexp;
   var Editbox16 = document.getElementById('Editbox16');
   if (!(Editbox16.disabled || Editbox16.style.display === 'none' || Editbox16.style.visibility === 'hidden'))
   {
      regexp = /^[-+]?\d*\.?\d*$/;
      if (Editbox16.value.length != 0 && !regexp.test(Editbox16.value))
      {
         alert("Please enter only digit characters in the \"Aantal\" field.");
         Editbox16.focus();
         return false;
      }
   }
   return true;
}
</script>
<script>
$(document).ready(function()
{
   $("#Form2").submit(function(event)
   {
      var isValid = $.validate.form(this);
      return isValid;
   });
   $("#Editbox8").validate(
   {
      required: true,
      bootstrap: true,
      type: 'text',
      length_min: '3',
      color_text: '#000000',
      color_hint: '#00FF00',
      color_error: '#FF0000',
      color_border: '#808080',
      nohint: false,
      font_family: 'Arial',
      font_size: '13px',
      position: 'topleft',
      offsetx: 0,
      offsety: 0,
      effect: 'none',
      error_text: 'Vul de naam van uw organisatie in'
   });
   $("#Combobox1").validate(
   {
      required: true,
      bootstrap: true,
      type: 'select',
      disallowfirstchoice: true,
      color_text: '#000000',
      color_hint: '#00FF00',
      color_error: '#FF0000',
      color_border: '#808080',
      nohint: false,
      font_family: 'Arial',
      font_size: '13px',
      position: 'topleft',
      offsetx: 0,
      offsety: 0,
      effect: 'none',
      error_text: 'Selecteer uw land'
   });
   $("#Editbox10").validate(
   {
      required: true,
      bootstrap: true,
      type: 'email',
      color_text: '#000000',
      color_hint: '#00FF00',
      color_error: '#FF0000',
      color_border: '#808080',
      nohint: false,
      font_family: 'Arial',
      font_size: '13px',
      position: 'topleft',
      offsetx: 0,
      offsety: 0,
      effect: 'none',
      error_text: 'Vul uw e-mail adres in'
   });
   $("#FileUpload1 :file").on('change', function()
   {
      var input = $(this).parents('.input-group').find(':text');
      input.val($(this).val());
   });
});
</script>
</head>
<body>
<div id="wb_Form2" style="position:absolute;left:0px;top:16px;width:419px;height:500px;z-index:28;">
<form name="Equipment_list_(NL)" method="post" action="<?php echo basename(__FILE__); ?>" enctype="multipart/form-data" target="_self" id="Form2" onsubmit="return submitEquipment_list_(NL)()">
<input type="hidden" name="formid" value="form2">
<label for="Editbox7" id="Label6" style="position:absolute;left:19px;top:15px;width:104px;height:16px;line-height:16px;z-index:0;">Name:</label>
<input type="text" id="Editbox7" style="position:absolute;left:180px;top:15px;width:190px;height:16px;z-index:1;" name="Naam" value="" spellcheck="false">
<label for="Editbox8" id="Label7" style="position:absolute;left:19px;top:46px;width:104px;height:16px;line-height:16px;z-index:2;">Organisation (*):</label>
<div id="wb_Editbox8" style="position:absolute;left:180px;top:46px;width:200px;height:26px;z-index:3;">
<input type="text" id="Editbox8" style="" name="Organisatie" value="" spellcheck="false">
<div class="invalid-feedback">Vul de naam van uw organisatie in</div></div>
<label for="Editbox9" id="Label8" style="position:absolute;left:19px;top:77px;width:104px;height:16px;line-height:16px;z-index:4;">Responsibility:</label>
<input type="text" id="Editbox9" style="position:absolute;left:180px;top:77px;width:190px;height:16px;z-index:5;" name="Functie" value="" spellcheck="false">
<label for="Combobox1" id="Label9" style="position:absolute;left:19px;top:108px;width:104px;height:16px;line-height:16px;z-index:6;">Country (*):</label>
<div id="wb_Combobox1" style="position:absolute;left:180px;top:108px;width:200px;height:28px;z-index:7;">
<select name="Land" size="1" id="Combobox1" style="">
<option value=""></option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde Islands">Cape Verde Islands</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Channel Islands">Channel Islands</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</option>
<option value="Guinea">Guinea</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mexico">Mexico</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="North Korea">North Korea</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Panama">Panama</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn Islands">Pitcairn Islands</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of Ireland">Republic of Ireland</option>
<option value="Republic Of Kazakhstan">Republic Of Kazakhstan</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Sao Tome">Sao Tome</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia and Montenegro">Serbia and Montenegro</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Korea">South Korea</option>
<option value="South Sandwich Islands">South Sandwich Islands</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="Uruguay">Uruguay</option>
<option value="USA">USA</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
<div class="invalid-feedback">Selecteer uw land</div></div>
<label for="Editbox10" id="Label10" style="position:absolute;left:19px;top:141px;width:104px;height:16px;line-height:16px;z-index:8;">E-mail (*):</label>
<div id="wb_Editbox10" style="position:absolute;left:180px;top:141px;width:200px;height:26px;z-index:9;">
<input type="text" id="Editbox10" style="" name="E-mail" value="" spellcheck="false">
<div class="invalid-feedback">Vul uw e-mail adres in</div></div>
<label for="Editbox11" id="Label11" style="position:absolute;left:19px;top:173px;width:104px;height:16px;line-height:16px;z-index:10;">Vendor:</label>
<input type="text" id="Editbox11" style="position:absolute;left:180px;top:173px;width:190px;height:16px;z-index:11;" name="Leverancier" value="" spellcheck="false">
<label for="Editbox12" id="Label12" style="position:absolute;left:19px;top:204px;width:104px;height:16px;line-height:16px;z-index:12;">Device name:</label>
<input type="text" id="Editbox12" style="position:absolute;left:180px;top:204px;width:190px;height:16px;z-index:13;" name="Naam apparaat" value="" spellcheck="false">
<label for="Editbox13" id="Label13" style="position:absolute;left:19px;top:235px;width:104px;height:16px;line-height:16px;z-index:14;">ID number:</label>
<input type="text" id="Editbox13" style="position:absolute;left:180px;top:235px;width:190px;height:16px;z-index:15;" name="Typenummer" value="" spellcheck="false">
<label for="Editbox14" id="Label14" style="position:absolute;left:19px;top:266px;width:126px;height:16px;line-height:16px;z-index:16;">UDI (EUDAMED):</label>
<input type="text" id="Editbox14" style="position:absolute;left:180px;top:266px;width:190px;height:16px;z-index:17;" name="UDI" value="Do not fill (n.a.)" readonly spellcheck="false">
<label for="Editbox15" id="Label15" style="position:absolute;left:19px;top:297px;width:104px;height:16px;line-height:16px;z-index:18;">Year of production:</label>
<input type="text" id="Editbox15" style="position:absolute;left:180px;top:297px;width:190px;height:16px;z-index:19;" name="Bouwjaar" value="" spellcheck="false">
<label for="Editbox16" id="Label16" style="position:absolute;left:19px;top:328px;width:104px;height:16px;line-height:16px;z-index:20;">Quantity:</label>
<input type="text" id="Editbox16" style="position:absolute;left:180px;top:328px;width:190px;height:16px;z-index:21;" name="Aantal" value="" spellcheck="false">
<label for="FileUpload1" id="Label17" style="position:absolute;left:19px;top:359px;width:104px;height:16px;line-height:16px;z-index:22;">Select list:</label>
<div id="FileUpload1" class="input-group" style="position:absolute;left:180px;top:359px;width:200px;height:26px;z-index:23;">
<input class="form-control" type="text" readonly="">
<label class="input-group-btn">
<input type="file" name="Bestand" id="FileUpload1-file" style="display:none;"><span class="btn">Browse...</span>
</label>
</div>
<div id="wb_RadioButton1" style="position:absolute;left:398px;top:281px;width:21px;height:17px;visibility:hidden;z-index:24;">
<input type="radio" id="RadioButton1" name="Name" value="on" style="position:absolute;left:0;top:0;visibility:hidden;"><label for="RadioButton1"></label></div>
<label for="TextArea1" id="Label1" style="position:absolute;left:19px;top:386px;width:92px;height:16px;line-height:16px;z-index:25;">Comments:</label>
<textarea name="TextArea1" id="TextArea1" style="position:absolute;left:180px;top:390px;width:190px;height:15px;z-index:26;" rows="1" cols="19" spellcheck="false"></textarea>
<input type="submit" id="Button1" name="Versturen" value="Verstuur" style="position:absolute;left:153px;top:450px;width:96px;height:27px;z-index:27;">
</form>
</div>
</body>
</html>