GIF89a;
Mini Shell
Mini Shell
<?
include("../lib/globals.php");
include("../lib/common.php");
include("../lib/functions.php");
$id=$_GET["id"];
$sql="select * from user_info where id='$id'";
$rs=execute_query($sql);
$row=mysql_fetch_array($rs);
function format_comment($str)
{
if($str=="")
{
return "None";
}
else
{
return $str;
}
}
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>:: swingers.it | Admin ::</title>
</head>
<link rel="stylesheet" type="text/css" href="../style.css" />
<body>
<br>
<div id="homebottom3">
<table width="800" border="0" align="center" class="Table">
<tr>
<td width="3%"> </td>
<td width="35%"> </td>
<td width="61%"> </td>
<td width="1%"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px; text-transform:uppercase;">
<strong>Personal Data :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Name :</strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['name']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Street Address : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['street_address']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>City : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['city']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>State : </strong></td>
<td align="left" class="gtext"><?=$row['state']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Zip : </strong></td>
<td align="left" class="gtext"><?=$row['zip']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Email : </strong></td>
<td align="left" class="gtext"><?=$row['email']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Phone : </strong></td>
<td align="left" class="gtext"><?=$row['phone']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Fax : </strong></td>
<td align="left" class="gtext"><?=$row['fax']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Marital Status : </strong></td>
<td align="left" class="gtext"><? if($row['marritual']=='Yes'){?>Single<? } else { ?>Married <? } ?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Homewoner? </strong></td>
<td align="left" class="gtext"><? if($row['marritual']=='Yes'){?>Yes<? } else { ?>No <? } ?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Currently Insured? </strong></td>
<td align="left" class="gtext"><?=$row['currently_insured']?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>DRIVER INFORMATION #1 :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Name :</strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv1_name']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Birth Date : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv1_dob']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Sex : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv1_sex']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Years U.S. Licensing : </strong></td>
<td align="left" class="gtext"><?=$row['drv1_lisence']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of Accidents last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv1_acc_type']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of MINOR Cites last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv1_minor_city']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of MAJOR Cites last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv1_major_city']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Daily commute in ONE WAY miles : </strong></td>
<td align="left" class="gtext"><?=$row['drv1_mile']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Does Driver need an SR22 FILING? </strong></td>
<td align="left" class="gtext"><? if($row['drv1_sr22_filling']=='Yes'){?>Yes<? } else { ?>No <? } ?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>If YES to SR22 filing, why needed?(list accident/cite)? </strong></td>
<td align="left" class="gtext"><? if($row['drv1_ssr2_why']=='Yes'){?>Yes<? } else { ?>No <? } ?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>DRIVER INFORMATION #2 :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Name :</strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv2_name']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Birth Date : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv2_dob']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Sex : </strong></td>
<td align="left" class="gtext"> <? print stripslashes($row['drv2_sex']);?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Years U.S. Licensing : </strong></td>
<td align="left" class="gtext"><?=$row['drv2_lisence']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of Accidents last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv2_acc_type']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of MINOR Cites last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv2_minor_city']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Number & Type of MAJOR Cites last 3 years : </strong></td>
<td align="left" class="gtext"><?=$row['drv2_major_city']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Daily commute in ONE WAY miles : </strong></td>
<td align="left" class="gtext"><?=$row['drv2_mile']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Does Driver need an SR22 FILING? </strong></td>
<td align="left" class="gtext"><? if($row['drv2_sr22_filling']=='Yes'){?>Yes<? } else { ?>No <? } ?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Comments or Remarks?</strong></td>
<td align="left" class="gtext"><? if($row['drv2_comments']=='Yes'){?>Yes<? } else { ?>No <? } ?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>VEHICLE #1 INFORMATION :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Year of vehicle :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_year']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Make & Model :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_model']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Annual Mileage :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_mileage']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Used in business?(Explain, if yes) :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_used']?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>VEHICLE #1 COVERAGES :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Limits of Liability :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_liability']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Comprehensive & Collision :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_comprehensive']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Do you want Medical Coverage?</strong></td>
<td align="left" class="gtext"><?=$row['vech1_medical']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Uninsured Motorists Cov.?</strong></td>
<td align="left" class="gtext"><?=$row['vech1_motorists']?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>VEHICLE #2 INFORMATION :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Year of vehicle :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_year']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Make & Model :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_model']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Annual Mileage :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_mileage']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Used in business?(Explain, if yes) :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_used']?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
<strong>VEHICLE #1 COVERAGES :</strong>
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Limits of Liability :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_liability']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Comprehensive & Collision :</strong></td>
<td align="left" class="gtext"><?=$row['vech2_comprehensive']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Do you want Medical Coverage?</strong></td>
<td align="left" class="gtext"><?=$row['vech2_medical']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Uninsured Motorists Cov.?</strong></td>
<td align="left" class="gtext"><?=$row['vech2_motorists']?></td>
<td> </td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Comments or Remarks :</strong></td>
<td align="left" class="gtext"><?=$row['vech1_comments']?></td>
<td> </td>
</tr>
<tr>
<td align="left" valign="top" class="gtext" colspan="4" style="border-bottom:2px solid #fff; padding-left:15px;">
</td>
</tr>
<tr>
<td> </td>
<td align="left" valign="top" class="gtext"><strong>Send my quotation via :</strong></td>
<td align="left" class="gtext"><?=$row['quotation']?></td>
<td> </td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"><a href="javascript:window.close()" class="footer-link">[ Close window ] </a></td>
</tr>
<tr>
<td colspan="4" align="center" class="gtext"> </td>
</tr>
</table>
</div>
</body>
</html>
./BlackJoker Mini Shell 1.0