<?php 
  $to = 'winsfolio@gmail.com' . "\r\n";
  $subject = 'Insurance Request From Qlik'; 
  $name = $_POST['complete_name'];
  $citizen_type = $_POST['citizen-type'];
  $email = $_POST['email_address'];  
  $education =$_POST['education'];
  $age =$_POST['age'];
  $dob =$_POST['dob']; 
  $address =$_POST['address'];  
  $ssn =$_POST['ssn'];
  $insurance =$_POST['insurance'];
  $liability =$_POST['liability']; 
  $years =$_POST['years'];
  $home_address =$_POST['home_address'];   
  $dollar =$_POST['dollar'];
  $mode =$_POST['mode'];
  $gender =$_POST['gender'];
  $term =$_POST['term'];
  
  
  
   
  $headers = "Reply-To: $name <$email>\r\n"; 
  $headers .= "Return-Path: The Sender <$email>\r\n"; 
  $headers .= "From: $email" ."\r\n" .
  $headers .= "Qlik Insurance Request\r\n";
  $headers .= "MIME-Version: 1.0\r\n";
  $headers .= "Content-type: text/html; charset=iso-8859-1\r\n";
  $headers .= "X-Priority: 3\r\n";
  $headers .= "X-Mailer: PHP". phpversion() ."\r\n" ;

  // prepare email body text
  $Body = "";
  $Body .= "*****Insurance Request From Qlik*****";
  $Body .= "\n"; 
  $Body .= "Full Name: ";
  $Body .= $name;
  $Body .= "\n";
  $Body .= "Citizen Type: ";
  $Body .= $citizen_type;
  $Body .= "\n";
  $Body .= "Email Address: ";
  $Body .= $email;
  $Body .= "\n";  
  $Body .= "Education: ";
  $Body .= $education;
  $Body .= "\n"; 
  $Body .= "Age: ";
  $Body .= $age;
  $Body .= "\n";
  $Body .= "Dob: ";
  $Body .= $dob;
  $Body .= "\n"; 
  $Body .= "Address: ";
  $Body .= $address;
  $Body .= "\n";
  $Body .= "Ssn: ";
  $Body .= $ssn;
  $Body .= "\n"; 
  $Body .= "Insurance: ";
  $Body .= $insurance;
  $Body .= "\n";
  $Body .= "Liability: ";
  $Body .= $liability;
  $Body .= "\n";
  $Body .= "Years: ";
  $Body .= $years;
  $Body .= "\n";
  $Body .= "Home Address: ";
  $Body .= $home_address;
  $Body .= "\n";
  $Body .= "Dollar: ";
  $Body .= $dollar;
  $Body .= "\n";
  $Body .= "Mode: ";
  $Body .= $mode;
  $Body .= "\n";
  $Body .= "Gender: ";
  $Body .= $gender;
  $Body .= "\n";
  $Body .= "term: ";
  $Body .= $term;
  $Body .= "\n";
  
  
  
  
  
 
  $mail = mail($to, $subject, $Body, $headers); 


  $subject = 'Thank You for Your Request on Qlik';
  $name = $_POST['complete_name'];
  $to = $_POST['email_address']; 

  // prepare email body text

  $Body = "Thank you for reaching out to us with your request.We have received your request for and are currently reviewing it. If you have any additional information or specific requirements, please feel free to share them with us. We will keep you updated and ensure a prompt response.
  Thank you for choosing Quiik";


  $headers = "Reply-To: Winsfolio <winsfolio@gnmail.com>\r\n"; 
  $headers .= "Return-Path: Quiik <winsfolio@gnmail.com>>\r\n"; 
  $headers .= "From: winsfolio@gnmail.com>" ."\r\n" .
  $headers .= "Qlik Service Maintenance\r\n";
  $headers .= "MIME-Version: 1.0\r\n";
  $headers .= "Content-type: text/html; charset=iso-8859-1\r\n";
  $headers .= "X-Priority: 3\r\n";
  $headers .= "X-Mailer: PHP". phpversion() ."\r\n" ;
  $mail = mail($to, $subject, $Body, $headers);

 ?> 