Contact Us

Empire State Medi-Cab
555 Broadhollow Road
Suite 301
Melville, New York 11747
Phone: 631-777-7333
Fax: 631-777-7335
Email:

For more specific information on what services Empire State Medi-Cab can perform for you, please fill out the page below. We accomodate many transportation needs. Our customers range from individuals to nursing facilities to hospitals to any party in need of our services. No request will be overlooked. Contact us to see how we can help you.

Fields marked with an * are required.

Your email address is invalid. Please enter a valid email address (yourname@domain.com)

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There was a problem submitting your form $name

$emailerrortext

Please be sure to complete all fields that are marked with a *

"; showform(); } else { // TIME $day = date("l"); $date = date("F jS, Y"); $longhour = date("Gi"); $hour = date("G", time()); $minutes = date("i"); // a $ip = "$REMOTE_ADDR"; $browplat = "$HTTP_USER_AGENT"; require("class.phpmailer.php"); $mail = new PHPMailer(); $mail->IsSMTP(); // set mailer to use SMTP $mail->Host = "mailhost.wwwebtek.com"; // specify main and backup server $mail->SMTPAuth = false; // turn on SMTP authentication $mail->From = "$email"; $mail->FromName = "$name"; $mail->AddAddress("info@empirestatemedicab.com", "Empire State Medi-Cab"); $mail->AddReplyTo("$email", "$name"); $mail->WordWrap = 50; // set word wrap to 50 characters //$mail->AddAttachment("/var/tmp/file.tar.gz"); // add attachments //$mail->AddAttachment("/tmp/image.jpg", "new.jpg"); // optional name $mail->IsHTML(true); // set email format to HTML $mail->Subject = "Contact Form from Empire Website"; $mail->Body = "** Contact Form from Empire Website **

====================================
Submitted: $day $date $hour:$minutes EST
====================================

General:
==========================
Name: $name
Company: $org
E-Mail: $email
Phone Number: $phone

Street Address:
$address
$city $states $zip

Comments or Questions:
$comments

====================================
====================================

ip address: $ip
browser & platform: $browplat
"; $mail->AltBody = ""; if(!$mail->Send()) { echo "

Message could not be sent $name

"; echo "

Pleae fill in a valid email address. Message could not be sent.

"; showForm(); //echo "Mailer Error: " . $mail->ErrorInfo; exit; } echo "

Thank you $name

Your information was submitted. A representative will be in touch with you. If you need immediate assistance, please call 631-777-7333

"; } } ?>
Contact Form: