Untitled

<!doctype html>

<?php

$servername = "localhost";
$username = "root";
$password = "";
$dbname = "db_dealer_track";
$conn = new mysqli($servername, $username, $password, $dbname);

if($conn->connect_error){
die("Connection failed". $conn->connect_error);
}


if(isset($_POST['id1'])){

$sql = "SELECT * FROM tbl_dealer_info ";
$sql .= "WHERE $account_name = 'account_name' ";
$result = mysqli_query($conn, $sql);
while($row = mysqli_fetch_array($result)){


?>

<html>
<head>
<title>iMobile </title>
</head>
<body bgcolor = "#D6DFE3">
<center><b><h2>Please enter the following information: </h2></b></center>

<form action = "dealer_track.php" method = "post">
<strong><center> <u>Fields marked with an asterisk(*) are required.</u><br><br>
Name of the dealer:*
<?php
$sql = "SELECT account_name FROM tbl_dealer_info ";
$result = mysqli_query($conn, $sql);
echo "<select name = 'account_name' id = 'id'>";
echo "<option value = ''>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['account_name'] . "'>" . $row['account_name'] . "</option>";
}
echo "</select>";
?>
<br><br>
<input type = submit id = "id1" name = "id1" value = "Display the fields" /><br>
</center>
<hr>
<br><br>

Phone:*<br>
<input type = "tel" name = "phone" pattern= "^d{3}-d{3}-d{4}$" onkeyup = "validate()" id = "id2" Required /><br><br>

// This is one of the things I tried to do with the value attribute. Still didn't work
Email:*<br>
<input type = "email" name = "email" id = "id3" value = "<?php echo $row['email']?>" Required /><br><br>

SFID:*<br>
<input type = "text" name = "sfid" id = "id4" Required /><br><br>

Account Name:*<br>
<input type = "text" name = "account_name" id = "id5" Required /><br><br>
Parent Account:*<br>
<input type = "text" name = "parent_account" id = "id6" Required /><br><br>
AWI Code:*<br>
<input type = "text" name = "awi_code"  id = "id7" Required /><br><br>
Sales Portal Id:*<br>
<input type = "text" name = "sales_portal_id" id = "id8" Required /><br><br>
IAE:*<br>
<input type = "text" name = "iae" id = "id9" Required /><br><br>
RSM:*<br>
<?php
$sql = "SELECT rsm_val FROM tbl_rsm_drop_down ";
$result = mysqli_query($conn, $sql);
echo "<select name = 'rsm_val'>";
echo "<option value = ''></option>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['rsm_val'] . "'>" . $row['rsm_val'] . "</option>";
}
echo "</select>";
?>
<br><br>
Prepaid Door Type:*<br>
<?php
$sql = "SELECT door_type_val FROM tbl_door_type_drop_down ";
$result = mysqli_query($conn, $sql);
echo "<select name = 'door_type_val'>";
echo "<option value = ''></option>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['door_type_val'] . "'>" . $row['door_type_val'] . "</option>";
}
echo "</select>";
?>
<br><br>
Payment Method:*<br>
<?php
$sql = "SELECT payment_method_val FROM tbl_payment_method_drop_down ";
$result = mysqli_query($conn, $sql);
echo "<select name = 'payment_method_val'>";
echo "<option value = ''></option>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['payment_method_val'] . "'>" . $row['payment_method_val'] . "</option>";
}
echo "</select>";
?>
<br><br>
Region:*<br>
<?php
$sql = "SELECT region_val FROM tbl_region_drop_down";
$result = mysqli_query($conn, $sql);
echo "<select name = 'region_val'>";
echo "<option value = ''></option>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['region_val'] . "'>" . $row['region_val'] . "</option>";
}
echo "</select>";
?>
<br>
<div align = "center" style= "margin-top:-44em">
Street Address:*<br>
<textarea name = "street_address" value = "street_address" Required /></textarea><br>
City:*<br>
<input type = "text" name = "city" id = "id15" Required /><br>
State:*<br>
<input type = "text" name = "state" id = "id16" Required /><br>
Zip code:*<br>
<input type = "text" name = "zip" id = "id17" Required /><br>
Area:*<br>
<input type = "text" name = "area" id = "id18" Required /><br>
Market:*<br>
<input type = "text" name = "market" id = "id19" Required /><br><br>
iPhone Boost Approved:
<input type = "radio" name = "boost_app" <?php if(isset($boost_app)&& $boost_app =="Yes")?> value = "Yes" />Yes
<input type = "radio" name = "boost_app" <?php if(isset($boost_app)&& $boost_app =="No")?> value = "No" />No<br><br>
iPhone Virgin Approved:
<input type = "radio" name = "virgin_app" <?php if(isset($virgin_app)&& $virgin_app =="Yes")?> value = "Yes" />Yes
<input type = "radio" name = "virgin_app" <?php if(isset($virgin_app)&& $virgin_app =="No")?> value = "No" />No<br><br>
VirginMobile Approved:
<input type = "radio" name = "virgin_mob_app" <?php if(isset($virgin_mob_app)&& $virgin_mob_app =="Yes")?> value = "Yes" />Yes
<input type = "radio" name = "virgin_mob_app" <?php if(isset($virgin_mob_app)&& $virgin_mob_app =="No")?> value = "No" />No<br><br>
Start Date:
<input type = "datepicker" placeholder = "YYYY-MM-DD" name = "tdate" value = "" id = "id20"/><br><br>
Bank Name:*<br>
<input type = "text" name = "bank_name" id = "id21" Required /><br><br>
Bank Account Number:*<br>
<input type = "text" name = "bank_account_number" id = "id22" onkeyup = "validate2()" Required /><br><br>
Routing Number:*<br>
<input type = "text" name = "routing_number" id = "id23" onkeyup = "validate3()" Required /><br><br>
Reason of call:*<br>
<?php
$sql = "SELECT type_of_call FROM tbl_call_types ";
$result = mysqli_query($conn, $sql);
echo "<select name = 'type_of_call' id = 'call_type' onchange = 'run()'>";
echo "<option value = ''>";
while($row = mysqli_fetch_array($result)){
    echo "<option value = '" .$row['type_of_call'] . "'>" . $row['type_of_call'] . "</option>";
}
echo "</select>";
?>
<br><br>
Comments:*<br>
<textarea name = "comments" value = "comments" id = "id24" Required /></textarea><br><br>
Timestamp(24-hr clock):*<br>
<input type = "text" placeholder = "YYYY-MM-DD HH-MM" name = "tdate" Required /><br><br>
</strong>
<center><br>
<input type="submit" name="submit" id = "id25" />
<style>
input[type=submit] {
    border-radius: 5px;
    border: 0;
    width: 140px;
    height:25px;
    font-family: Tahoma;
    background: #f4f4f4;
    /* Old browsers */
    background: -moz-linear-gradient(top, #f4f4f4 1%, #ededed 100%);
    /* FF3.6+ */
    background: -webkit-gradient(linear, left top, left bottom, color-stop(1%, #f4f4f4), color-stop(100%, #ededed));
    /* Chrome,Safari4+ */
    background: -webkit-linear-gradient(top, #f4f4f4 1%, #ededed 100%);
    /* Chrome10+,Safari5.1+ */
    background: -o-linear-gradient(top, #f4f4f4 1%, #ededed 100%);
    /* Opera 11.10+ */
    background: -ms-linear-gradient(top, #f4f4f4 1%, #ededed 100%);
    /* IE10+ */
    background: linear-gradient(to bottom, #59A0F2 1%, #ededed 100%);
    /* W3C */
    filter: progid:DXImageTransform.Microsoft.gradient(startColorstr='#f4f4f4', endColorstr='#ededed', GradientType=0);
    /* IE6-9 */
    </style>
</div>
</form>
<?php
}}  // While loop and if loop at the start
?>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<script>

//Javascript codes below
function validate(){
    var element = document.getElementById("id2");
    element.value = element.value.replace(/[^0-9-]+/,'');
}
function validate2(){
    var element = document.getElementById("id22");
    element.value = element.value.replace(/[^0-9-]+/,'');
}
function validate3(){
    var element = document.getElementById("id23");
    element.value = element.value.replace(/[^0-9-]+/,'');
}
function run(){
    document.getElementById("id24").innerHTML = document.getElementById("call_type").value;
}
</script>
</body>
</html>