Additional Features to Existing PHP/MySQL Site

The "Request A Quote" portion of the PA Auto Insurance Outlet website ([login to view URL]) needs to be expanded to include "Homeowner's Insurance" and "Commercial Auto Insurance". The layout should be the same as the "Auto Insurance" pages. The required fields are listed in the extended information for bid. ## Deliverables For commercial drivers insurance: Page 1: Business Information Please select your company type: [Dropdown] - Individual/Sole Proprietorship - Corporation - Partnership - Charitable Organization - County Government - Educational System - Municipality - Non-Profit Organization - State Government - Township - Other Please select your business type: [Dropdown] - Amish Taxi Services - Construction and Contractors - Courier Services - Dirt, Sand, Gravel, Rock, and Asphalt Haulers - Farming, Ranching, Fisheries and Nurseries - Funeral Services - Ice Cream Vendors - Landscaping, Snowplowing, and Firewood Hauling - Newspaper or Mail Delivery - Passenger Transportation (Not For Hire) - Pizza and Fast Food Delivery - Sales Reps, Realtors, Consultants or Financial Co. - Septic Waste, Scrap Metal and Recyclables - Trucking or Transportation of Goods - Towing or Service Stations - Other Buttons: Cancel, Continue Page 2: Driver(s) Information Text Entry: First Name Text Entry: Last Name (optional) Date Entry: Date of Birth (optional) Text Entry: Rating Age Drop down: Marital Status - Married - Divorced - Single - Widowed Drop down: Relation to Insured - Self - Spouse - Child - Other Drop down: Does the driver have an international or foreign license? - No - Yes Drop down: Does the driver have a Commercial Drivers License (CDL)? - No - Yes Buttons: Back, Cancel, Add Another Driver, Remove Driver, Continue Page 3: Vehicle Information - We expect changes to this page, but here's the basics Text Entry: VIN Text Entry: Year Text Entry: Make Text Entry: Model Text Entry: Vehicle Type Text Entry: Body Style Text Entry: Gross Vehicle Weight Drop down: Radius of Operation - 0-75 Miles - 76-150 Miles - 151+ Text Entry: Garaging Zip Code Text Entry: Garaging Ciry Buttons: Back, Cancel, Add Another Vehicle, Continue Page 4: Coverages Text Entry: Stated amount of vehicle and equipment (include value of ALL permanently attached equipment). The stated amount entered should be the current value of the vehicle, not the cost new. Drop down: Comprehensive deductible - None - $100 - $250 - $500 - $1000 Drop down: Collision deductible - None - $100 - $250 - $500 - $1000 Buttons: Back, Cancel, continue Page 5: Prior Coverage Drop down: Has the applicant been covered by a commercial auto policy without lapse for a minimum of 12 months? - No - Yes Text Entry: Prior Commercial Auto Provider Drop down: Limits - I'll have to get your these values Buttons: back, cancel, continue Page 6: General Questions Date Entry: When did the applicant begin doing business under the current name? Drop down: Does the applicant have an in-force General Liability (GL) or Business Owners Policy (BOP) with another insurer? - None - Yes -- If YES: What Company? Drop down: Are all listed vehicles registered and garaged in the state of Pennsylvania? - Yes - No Drop down: Are all listed drivers covered by a Workers Compensation Policy? - No - Yes buttons: back, cancel, continue Page 7: Quote Text entry: Applicant First Name Text entry: Applicant Last Name Text entry: Doing business as (if applicable) Date Entry: Effective Date Drop down: Bodily Injury - Reject - 15k/30k/5k - 25/50/15 - 50/100/25 - 100/300/50 - 100/300/100 - 250/500/100 - 35k CSL - 100k CSL - 300k CSL - 500k CSL - 1,000,000 CSL Drop down: Uninsured Motorist - Reject - (SAME CHOICES AS ABOVE) Drop down: Underinsured Motorist - Reject - (SAME CHOICES AS ABOVE) Drop down: Medical Expense - None - 5k - 10k - 25k - 50k - 100k Drop down: Income Loss Benefit - 1000/5000 - 1000/10000 - 2000/10000 Drop down: Number of employees - 1-5 - 6-10 - 10+ Buttons: back, cancel, continue Page 8: Insurance Score Text entry: First Name Text entry: Last Name Date entry: Date of Birth Text entry: Social Security Number Drop down: Has driver moved to a new residence within the last 60 days? - No - Yes Current Mailing Address: Text entry: Address (2 lines) Text entry: Zip Code Text entry: City Drop down: State - (All states) Buttons: back, cancel, request quote For the Homeowner's Quote: Page 1: Contact Information Text entry: Full Name Mailing Address: Text entry: Address (Two Lines) Text entry: City Drop down: State - (All states) Text entry: Zip Code Phone Info: Text entry: Home Phone Text entry: Work Phone (optional) Text entry: Cell Phone (optional) buttons: cancel, continue Page 2: Personal Information Text entry: Full Name (Get value from page 1) Date entry: Date of Birth Text entry: Social Security Number Drop down: Marital Status - (SAME AS ABOVE) Text entry: Occupation buttons: cancel, add another insured, remove, continue Page 3: Property Information (Get values from page 1) Text entry: Address (Two Lines) Text entry: City Drop down: State - (All states) Text entry: Zip Code Drop down: Any animals on site? - No - Yes Drop down: Any losses in 3 years? - No - Yes Drop down: Within 5 miles of a Fire Station? - No - Yes Drop down: Within 1000 ft of a hydrant? - No - Yes buttons: back, cancel, continue Page 4: Building Information Text entry: Year Built Drop down: Style - (Will get this info) Text entry: Number of Stories Text entry: Total Living Area (in Sq. Ft.) Foundation Type (In Percentages): Text entry: Slab Text entry: Crawl Space Text entry: Basement Text entry: Piers (raised) Text entry: Suspended over hillside -- NOTE: total percentage must == 100% buttons: back, cancel, continue Page 5: Exterior Walls Exterior Walls (In Percentages): Text entry: Brick on Frame Text entry: Brick, solid Text entry: Concrete Block, Painted Text entry: Shakes, Wood Text entry: Siding, Aluminum Text entry: Siding, Clapboard Text entry: Siding, Vinyl Text entry: Siding, Wood Text entry: Stone on Frame Text entry: Stone, Solid 24" Text entry: Stucco on Frame Text entry: Siding, Cement Fiber -- NOTE: total percentage must == 100% buttons: back, cancel, continue Page 6: Roof Roof (In Percentages): Text entry: Built-Up/Tar and Gravel Text entry: Shingles, Architectural Text entry: Rubber Text entry: Shakes, Wood Text entry: Shingles, Asphalt/Fiberglass Text entry: Shingles, Wood Text entry: Slate Text entry: Tile, Clay Text entry: Tile, Concrete Text entry: Tin Text entry: Hail Proof -- NOTE: total percentage must == 100% buttons: back, cancel, continue Page 7: Interior (Kitchen) Please enter the number of Kitchens Text entry: Kitchen, Basic Text entry: Kitchen, Builder's Grade Text entry: Kitchen, Semi-Custom Text entry: Kitchen, Custom Text entry: Kitchen, Designer buttons: back, cancel, continue Page 8: Interior (Baths) Please enter the number of Baths Text entry: Full Bath, Basic Text entry: Full Bath, Builder's Grade Text entry: Full Bath, Semi-Custom Text entry: Full Bath, Custom Text entry: Full Bath, Designer Text entry: Half Bath, Basic Text entry: Half Bath, Builder's Grade Text entry: Half Bath, Semi-Custom Text entry: Half Bath, Custom Text entry: Half Bath, Designer Text entry: Three-Quarter Bath, Basic Text entry: Three-Quarter Bath, Builder's Grade Text entry: Three-Quarter Bath, Semi-Custom Text entry: Three-Quarter Bath, Custom Text entry: Three-Quarter Bath, Designer buttons: back, cancel, continue page 9: Heating and Cooling Please enter the percentage of your home covered by the following: Text entry: Central Air Conditioning, Avg Cost Text entry: Heat/Central Air Conditioning, Avg Cost Text entry: Central Air Conditioning, Same ducts Text entry: Heating System, Average Cost Text entry: Central Air Conditioning, Separate Ducts Text entry: Heating, Electric Text entry: Evaporative Cooler Text entry: Heating, Gas Text entry: Heating, Oil -- NOTE: total percentages must == 100% buttons: back, cancel, continue page 10: Garages & Carports Text entry: Attached Garage, 1 Car Text entry: Attached Garage, 2 Car Text entry: Attached Garage, 3 Car Text entry: Basement Garage, 1 Car Text entry: Basement Garage, 2 Car Text entry: Basement Garage, 3 Car Text entry: Built-In Garage, 1 Car Text entry: Built-In Garage, 2 Car Text entry: Built-In Garage, 3 Car Text entry: Detached Garage w/ Finished Area, 1 Car Text entry: Detached Garage w/ Finished Area, 2 Car Text entry: Detached Garage w/ Finished Area, 3 Car Text entry: Detached Garage, 1 Car Text entry: Detached Garage, 2 Car Text entry: Detached Garage, 3 Car Text entry: Carport Garage, 1 Car Text entry: Carport Garage, 2 Car Text entry: Carport Garage, 3 Car buttons: back, cancel, continue Page 11: attached structures Please enter the size (in Sq. Ft.) of any of the following structures attached to your house: Text entry: Open Porch Text entry: Screened Porch Text entry: Enclosed Porch Text entry: Open Breezeway Text entry: Screened Breezeway Text entry: Enclosed Breezeway Text entry: Wood Deck Text entry: Redwood Deck Text entry: Greenhouse buttons: back, cancel, submit quote