X-Git-Url: http://git.hcoop.net/clinton/MarylandElectronicPetitionSignature.git/blobdiff_plain/76e48b4fc91d2f0dd096091bf6953b8170f698c2..aa8652937ff738bbc5f5b6faeeb8304eebfacb49:/enter_information.php diff --git a/enter_information.php b/enter_information.php index 86cfdb2..7efb9f9 100644 --- a/enter_information.php +++ b/enter_information.php @@ -1,9 +1,24 @@ + + + query($qX); $dX = mysqli_fetch_array($rX); ?>
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E-Mail for Follow Up*

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First Name

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First Name

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Last Name

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Last Name

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Date of Birth

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Date of Birth

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Phone Number

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Phone Number**

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House Number

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Phone Format

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443-123-4567

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Building Number

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ZIP Code

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House: 321 Here St.

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Use: 321

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Apartment: 21 Here St. Apt 1323

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Use: 21

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ZIP Code

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ZIP Code Format

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55555

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* E-Mail is not required, and will only be used with the petitioners to reach you. It will never be sold.
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** PHONE NUMBER IS REQUIRED BY STATE OF MARYLAND. WE WILL NEVER USE YOUR PHONE NUMBER - NEVER CALL - NEVER FOR TEXT MESSAGES.
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