$value) { $$key = $value; } if(!$insuranceName) {$msg = "Please enter your Insurance Company Name"; $error = true;} if(!$amBest) {$msg = "Please enter your AM Best Rating"; $error = true;} if(!$address1) {$msg = "Please enter your Address"; $error = true;} if(!$city) {$msg = "Please enter your City"; $error = true;} if(!$state) {$msg = "Please enter your State"; $error = true;} if(!$zip) {$msg = "Please enter your Zip Code"; $error = true;} if(!$insurancePhone) {$msg = "Please enter your Insurance Phone Number"; $error = true;} if(!$administrativeName) {$msg = "Please enter your Administrative Contact Name"; $error = true;} if(!$administrativePhone) {$msg = "Please enter your Administrative Contact Phone Number"; $error = true;} if(!$administrativeEmail) {$msg = "Please enter your Administrative Contact E-mail"; $error = true;} if(!$underwritingName) {$msg = "Please enter your Underwriting Contact Name"; $error = true;} if(!$underwritingPhone) {$msg = "Please enter your Underwriting Contact Phone Number"; $error = true;} if(!$underwritingEmail) {$msg = "Please enter your Underwriting Contact E-mail"; $error = true;} if(!$username) {$msg = "Please enter a valid Username"; $error = true;} if(!$password1) {$msg = "Please enter a valid Password"; $error = true;} if($password1 != $password2) {$msg = "Please ensure your passwords match"; $error = true;} if(!$samplePolicy) {$msg = "Please include a sample policy PDF file";} if(!$companyLogo) {$msg = "Please include a logo image file";} if(!$officer_agree) {$msg = "Please include a corporate officer name to agree to the terms of use";} //CHECK VERIFICATION CODE if(($_SESSION['security_code'] == $_POST['security_code']) && (!empty($_SESSION['security_code'])) ) { // Insert you code for processing the form here, e.g emailing the submission, entering it into a database. unset($_SESSION['security_code']); } else {$msg = "Incorrect Verification Code: Please enter the human verification field correctly"; $error = true;} //------// $sql = "SELECT username FROM accounts WHERE username='$username'"; $result = mysql_query($sql); while($row=mysql_fetch_array($result)) { $found_username = $row["username"]; } if($found_username) {$msg = "This username has already been taken, please select another."; $error = true;} else if( (ereg('[^A-Za-z0-9]', $username)) || (strlen($username) > 10) ) {$msg = "Invalid username. Please ensure the name consists of only letters and numbers and is less than 10 characters long."; $error = true;} else if(!$error) { //CREATE POLICY FOLDER if(!file_exists("insurers/$username/")) { mkdir("insurers/$username/", 0777); chmod("insurers/$username", 0777); } $target_path = "insurers/$username/"; if ( $_FILES["samplePolicy"]["type"] == "application/pdf" && $_FILES["samplePolicy"]["size"] < 10485760 ) { if ($_FILES["samplePolicy"]["error"] > 0) { $msg = "Return Code: " . $_FILES["samplePolicy"]["error"] . "
"; } else { /* echo "Upload: " . $_FILES["samplePolicy"]["name"] . "
"; echo "Type: " . $_FILES["samplePolicy"]["type"] . "
"; echo "Size: " . ($_FILES["samplePolicy"]["size"] / 1024) . " Kb
"; echo "Temp file: " . $_FILES["samplePolicy"]["tmp_name"] . "
"; */ if (file_exists($target_path . $_FILES["samplePolicy"]["name"])) $msg = $_FILES["samplePolicy"]["name"] . " already exists. "; else move_uploaded_file($_FILES["samplePolicy"]["tmp_name"],$target_path . $_FILES["samplePolicy"]["name"]); } } else { $msg = "Invalid file"; } //CREATE E&O FOLDER $target_path = "agents/$username/"; if ((($_FILES["companyLogo"]["type"] == "image/gif") || ($_FILES["companyLogo"]["type"] == "image/jpeg") || ($_FILES["companyLogo"]["type"] == "image/pjpeg")) && ($_FILES["companyLogo"]["size"] < 100000)) { if ($_FILES["companyLogo"]["error"] > 0) { $msg = "Return Code: " . $_FILES["companyLogo"]["error"] . "
"; } else { if (file_exists($target_path . $_FILES["companyLogo"]["name"])) $msg = $_FILES["companyLogo"]["name"] . " already exists. "; else move_uploaded_file($_FILES["companyLogo"]["tmp_name"],$target_path . $_FILES["companyLogo"]["name"]); } } else { $msg = "Please ensure your logo is of type gif or jpeg and under 100 KB"; } $now = time(); if($agentRequired) $agentRequired = 1; else $agentRequired = 0; if($disallowed_agents == "Enter each disallowed agent insurance license separated by commas") $disallowed_agents = ""; else $disallowed_agents = ",".$disallowed_agents; $sql = "INSERT INTO accounts (username,password,enrollment_date,type) VALUES('$username','$password1','$now','insurer')"; mysql_query($sql); $insurer_id = mysql_insert_id(); $sql = "INSERT INTO insurance_contact_info (user_id,insurance_name,am_best,address1,address2,city,state,zip,phone,administrative_name,administrative_phone,administrative_email,underwriting_name,underwriting_phone,underwriting_email,agent_required,samplePolicy,companyLogo,disallowed_agents,enrollment_date) VALUES ('$insurer_id','$insuranceName','$amBest','$address1','$address2','$city','$state','$zip','$insurancePhone','$administrativeName','$administrativePhone','$administrativeEmail','$underwritingName','$underwritingPhone','$underwritingEmail','$agentRequired','$samplePolicy','$companyLogo','$disallowed_agents','$now')"; mysql_query($sql) or die(mysql_error()); session_start(); unset($_SESSION["user_id"]); unset($_SESSION["agent_id"]); unset($_SESSION["insurer_id"]); unset($_SESSION["buyerLogged"]); $_SESSION["insurer_id"] = $insurer_id; $_SESSION["username"] = $username; $_SESSION["first_name"] = $first_name; $_SESSION["last_name"] = $last_name; header("Location: insurance-administration.php"); } } ?> My True Quote - Get Every Quote, Every Time!

Insurance Company / MGA Enrollment

$msg";?>
Company Information









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Administrative Contact






Underwriting Contact






Account Information

(Limit 10 characters of letters and numbers only)



(Corporate Officer Name)

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