Enquiry form with validation & facebox

<script language="JavaScript">
<!--

/***********************************************
* Required field(s) validation v1.10- By NavSurf
* Visit Nav Surf at http://navsurf.com
* Visit http://www.dynamicdrive.com/ for full source code
***********************************************/

function formCheck(formobj){
	// Enter name of mandatory fields
	var fieldRequired = Array("name", "email", "tel", "address", "country");
	// Enter field description to appear in the dialog box
	var fieldDescription = Array("Name", "Email", "Telephone", "Address", "Country");
	// dialog message
	var alertMsg = "Please complete the following fields:\n";

	var l_Msg = alertMsg.length;

	for (var i = 0; i < fieldRequired.length; i++){
		var obj = formobj.elements[fieldRequired[i]];
		if (obj){
			switch(obj.type){
			case "select-one":
				if (obj.selectedIndex == -1 || obj.options[obj.selectedIndex].text == ""){
					alertMsg += " - " + fieldDescription[i] + "\n";
				}
				break;
			case "select-multiple":
				if (obj.selectedIndex == -1){
					alertMsg += " - " + fieldDescription[i] + "\n";
				}
				break;
			case "text":
			case "textarea":
				if (obj.value == "" || obj.value == null){
					alertMsg += " - " + fieldDescription[i] + "\n";
				}
				break;
			default:
			}
			if (obj.type == undefined){
				var blnchecked = false;
				for (var j = 0; j < obj.length; j++){
					if (obj[j].checked){
						blnchecked = true;
					}
				}
				if (!blnchecked){
					alertMsg += " - " + fieldDescription[i] + "\n";
				}
			}
		}
	}

	if (alertMsg.length == l_Msg){
		return true;
	}else{
		alert(alertMsg);
		return false;
	}
}
// -->
</script>

<script>
function quoteme() {
        $("#msgbox_body").html('<div id="contactform" style="margin-left:20px;margin-right:20px;margin-top:10px;"><form class="form" onsubmit="return formCheck(this);" method="POST" action="http://www.dtrmedical.com"><table border="0"><tbody><tr><td><p class="name"><label for="name">Your Name<span style="color:red;">*</span>:</label></p></td><td>&nbsp;</td><td><input type="text" name="name" id="name" /></td></tr><tr><td><p class="hospital"><label for="hospital">Hospital/Institution:</label></p></td><td>&nbsp;</td><td><input type="text" name="hospital" id="hospital" /></td></tr><tr><td><p class="department"><label for="department">Department:</label></p></td><td>&nbsp;</td><td><input type="text" name="department" id="department" /></td></tr><tr><td><p class="address"><label for="address">Address<span style="color:red;">*</span>:</label></p></td><td>&nbsp;</td><td><input type="text" name="address" id="address" /></td></tr><tr><td><p class="country"><label for="country">Country<span style="color:red;">*</span>:</label></p></td><td>&nbsp;</td><td><input type="text" name="country" id="country" /></td></tr><tr><td><p class="email"><label for="email">E-mail<span style="color:red;">*</span>:</label></p></td><td>&nbsp;</td><td><input type="text" name="email" id="email" /></td></tr><tr><td><p class="tel"><label for="tel">Telephone<span style="color:red;">*</span>:</label></p></td><td>&nbsp;</td><td><input type="text" name="tel" id="tel" /></td></tr><tr><td colspan="3" align="center"><p class="submit"><input style=\"margin-left:27px;cursor:pointer;\" onClick="jQuery.facebox({ ajax: (\'wishlist.php?emailme=true&name=\' + this.form.name.value + \'&country=\' + this.form.country.value + \'&email=\' + this.form.email.value + \'&address=\' + this.form.address.value + \'&tel=\' + this.form.tel.value + \'&hospital=\' + this.form.hospital.value + \'&department=\' + this.form.department.value) }); return false;" type="submit" value="Send enquiry" name="submit" /></p></td><td>&nbsp;</td><td>&nbsp;</td></tr></tbody></table></form></div>');
        $("#msgbox_actions").html('<input onclick="jQuery.facebox({ ajax: \'wishlist.php?basket=true\' })" type="button" value="Back to Wishlist" />');
}
</script>
<? if (!$listempty) { ?>
<div id="msgbox_actions"><input onclick="quoteme()" type="button" value="Request quote/sample" /> <a class="backtoproducts" href="http://www.dtrmedical.com/products" style="border-bottom-left-radius:5px 5px;border-bottom-right-radius:5px 5px;border-bottom-style:none;border-color:initial;border-left-style:none;border-right-style:none;border-top-left-radius:5px 5px;border-top-right-radius:5px 5px;border-top-style:none;border-width:initial;color:white;font-family:Arial;padding-bottom:2px;padding-left:6px;padding-right:6px;padding-top:2px;font-size:11px;">Back to products</a></div><!-- <input type="submit" value="Update" /> --><!-- <input onclick="jQuery.facebox({ ajax: 'wishlist.php?emailme=true' })" type="button" value="Save list for later" /> --> <!-- <input type="submit" value="Update Qty's" /> <input onclick="jQuery.facebox({ ajax: 'wishlist.php?basket=true&clearall=true' })" type="button" value="Clear list" /> -->
<? } ?>
</form>
<? } //REMOVED </div> just before here ?>

<?php
// if send email
if(isset($_GET['emailme']) && $_GET['emailme'] == 'true') {
	// to and subject
	$to = "[email protected]";
	$subject = "DTR Medical website - Product enquiry";

	// get these from query string
	$name_field = $_GET['name'];
	$hospital_field = $_GET['hospital'];
	$address_field = $_GET['address'];
	$country_field = $_GET['country'];
	$department_field = $_GET['department'];
	$email_field = $_GET['email'];
	$tel_field = $_GET['tel'];

	// get wishlist
	$query = "SELECT w.*, p.product_name, q.quantity_name, o.product_code, o.description
				FROM wishlistbasket w, products p, product_quantities q, product_options o
				WHERE sesid = '$sesid' AND w.pid = p.id AND w.qid = q.id AND w.oid = o.id ORDER BY w.pid, w.qid, w.oid";
	$res = mysql_query($query);
	$wish_list = '';
	if($res){
		while($row = mysql_fetch_assoc($res)) {
			if ($row['qty'] == 1) {
				$row['qty'] = "Quote";
			} else if ($row['qty'] == 2) {
				$row['qty'] = "Sample";
			} else if ($row['qty'] == 3) {
				$row['qty'] = "Quote and Sample";
			}
			$wish_list .= $row['product_code'] . ' - ' . $row['product_name'] . ', ' . $row['quantity_name'] . ', ' . $row['qty'] . '' . $row['product_options'] . "
			\n";
		}
	}

	// build mail body
	$body = "DTR Medical,\n\n
You have an enquiry from the website, please see the details below:\n\n
Name: $name_field\n
Hospital/institution: $hospital_field\n
Department: $department_field\n
Address: $address_field\n
Country: $country_field\n
E-Mail: $email_field\n
Tel: $tel_field\n
Wishlist:\n $wish_list";
	mail($to, $subject, $body);
	echo "<div style=\"margin:20px;\">Thank you for your enquiry. We will be in touch within 48 hours.<br /> <br />If you would like to get in touch regarding your enquiry then please call us on:<br /> +44 (0) 1792 79 79 10<br /><br /><div onclick=\"location.href='/products\" style=\"margin-left:135px;cursor: pointer; margin-top: 10px; border-top-left-radius: 5px 5px; border-top-right-radius: 5px 5px; border-bottom-right-radius: 5px 5px; border-bottom-left-radius: 5px 5px; background-color:#663399; width: 143px; height: 30px;\"><a style=\"  color:white;display:block;float:right;height:26px;margin-top:4px;padding-left:0px;padding-top:5px;width:120px;\" href=\"/products\" class=\"basket\">Back to products</a></div></div>";}
?>