To: {#email#}
From: <info@email-form.com>
Subject: MySQL DB Form - Demo

Dear Customer,
Here is information that you have filled in on MySQL DB Form - Demo at Email-Form.com

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Time and Date of Submission: {#%DATE#}

Unique Reference Number: {#%unique_reference#}

Contact eMail: {#email#}

Individual or  Company:
{#type_of_person#}

Country:
{#country#}

How did you find us?
{#referrer#}

The form submited on {#%HTTP_REFERER#}
IP address is {#%REMOTE_ADDR#}
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