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+-----------------------------------+---------------------+
| Irszam:                           | input mező         |
| Város:                            | input mező         |
| Utca:                             | input mező         |
| checkbox elfogadom...            |                      |
+-----------------------------------+----------------------+
 

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...
$txt .= "<tr><td>Irányítószám (számlázási):</td><td><input type=\"text\" name=\"iszam\" /></td></tr>";
    $txt .= "<tr><td>Város (számlázási):</td><td><input type=\"text\" name=\"varos\" /></td></tr>";
    $txt .= "<tr><td>Utca, házszám (számlázási):</td><td><input type=\"text\" name=\"utca\" /></td></tr>";
    
 
    $txt .= "<tr><td align=\"center\" ><font color=red><sup>*</sup></font><input type=\"checkbox\" value=\"0\" name=\"agree\" 
    onclick=\"document.getElementById('button_send').disabled = !this.checked;\"> Elfogadom az általános szerződési feltételeket! </td></tr>";
...
 

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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html>
<head>
<meta http-equiv="content-language" content="en">
<meta name="Author" content="jeanray charlier"> 
<meta name="copyright" content="jeanray charlier">
<style type="text/css">
body
{
    FONT-FAMILY: verdana, arial, times;
    font-size: 12px;
    color: #000000;
    margin: 0 0 0 0;
} 
.title
{
    color: #0000FF;
    font-size: 14px;
    font-weight: bold;
}
</style>
<?php
    // YOUR EMAIL ADDRESS
    define ("MYEMAIL",""); // YOU MUST ENTER YOUR EMAIL HERE
 
function show_form()
{
    $txt  = "<p class=\"title\" align=\"center\"><b>Form to email Script</b></p>";
    $txt .= "<form name=\"f2email\" action=\"".$_SERVER['PHP_SELF']."\" method=\"POST\">";
    $txt .= "<table align=\"center\">";
    $txt .= "<tr><td>Your name:</td><td><input type=\"text\" name=\"name\" /></td></tr>";
    $txt .= "<tr><td>Your email:</td><td><input type=\"text\" name=\"email\" /></td></tr>";
    $txt .= "<tr><td>Subject:</td><td><input type=\"text\" name=\"subject\" size=\"40\" /></td></tr>";
    $txt .= "<tr><td colspan=\"2\">Your Comment:</td></tr>";
    $txt .= "<tr><td colspan=\"2\"><textarea name=\"comment\" rows=\"5\" cols=\"60\"></textarea></td></tr>";
    $txt .= "<tr><td colspan=\"2\" align=\"right\">";
    $txt .= "<input type=\"button\" name=\"send\" value=\"Send\" 
                onclick=\"js_validate(document.forms['f2email']); return false;\" /></td></tr>";
    
    // REMOVE THE FOLLOWING LINES WHEN YOU HAVE DEFINED "MYEMAIL"
    if (MYEMAIL == "")
    {
        $txt .= "<tr><td>Email To:</td><td><input type=\"text\" name=\"toemail\" /></td></tr>";
        $txt .= "<tr><td colspan=\"2\" >(You must edit the code and define \"MYEMAIL\")</td></tr>";
    }
    // ===================================================================
    $txt .= "</table>";
    $txt .= "<input type=\"hidden\" name=\"submitted\" value=\"submitted\" />";
    $txt .= "</form>";
    return($txt);
}
function treat_submission()
{
    $name = $_POST['name']; // VISITOR'S NAME
    $email = $_POST['email']; // VISITOR'S EMAIL
    $subject = $_POST['subject'];
    $comment = $_POST['comment'];
    if (MYEMAIL == "")
        $my_email = $_POST['toemail']; // use this line if MYEMAIL is not defined
    else
        $my_email = MYEMAIL;    // Use this one if MYEMAIL is defined
    // =========================================================
    // THE MESSAGE
    $headers = "To: ".$my_email. "\r\n";
    $headers .= "From: ".$email. "\r\n";
    $msg = $name." has submitted a comment:\r\n\r\n";
    $msg .= $comment."\r\n\r\n";
    mail($my_email, $subject, $msg, $headers);
    // MESSAGE TO VISITOR:
    $headers = "To: ".$email. "\r\n"; // this is the email given by the visitor
    $headers .= "From: ".$my_email. "\r\n";
    $subject = "Your message to ".$my_email;
    $msg = "Thank you for contacting us.\r\n\r\n";
    $msg .= "We will endeavour to respond shortly.\r\n\r\n";
    mail($email, $subject, $msg, $headers);
    $txt = "<p align=\"center\">Your email has been sent</p>";
    return($txt);
}
?>
<script type='text/javascript' language='JavaScript'>
function showform(theForm)
{
    var txt = "Form name: " + theForm.name + "\r\n";
    txt += "theForm.elements.length = "+theForm.elements.length+"\r\n";
    for (var i=0; i<theForm.elements.length; i++)
        txt += theForm.elements[i].name + " = " + theForm.elements[i].value + "\r\n";
    alert(txt);
}
function js_validate(theForm)
{
    showform(theForm); // remove when you don't need it
    // Check for name
    var name = theForm.elements['name'].value;
    if (name == "")
    {
        alert ("You must enter your name");
        theForm.elements['name'].focus();
        return true;
    }
    // Check email address
    var email = theForm.elements['email'].value;
    if (echeck(email))
    {
        alert ("You must enter a valid email address");
        theForm.elements['email'].focus();
        return true;
    }
    // Check if subject is not blank
    var sbj = theForm.elements['subject'].value;
    if (sbj == "")
    {
        alert ("You must enter a subject");
        theForm.elements['subject'].focus();
        return true;
    }
    // Check if comment is not blank
    var comt = theForm.elements['comment'].value;
    if (comt == "")
    {
        alert ("You must enter a comment");
        theForm.elements['comment'].focus();
        return true;
    }
    theForm.submit();   // form is ok, we can submit it!
}
// === EMAIL VALIDATION =================================================================================================================================
function echeck(str) 
{
    var at="@"
    var dot="."
    var lat=str.indexOf(at)
    var lstr=str.length
    var ldot=str.indexOf(dot)
    if (str.indexOf(at)==-1)
       return(true);
    if (str.indexOf(at)==-1 || str.indexOf(at)==0 || str.indexOf(at)==lstr)
        return(true);
    if (str.indexOf(dot)==-1 || str.indexOf(dot)==0 || str.indexOf(dot)==lstr)
        return(true);
    if (str.indexOf(at,(lat+1))!=-1)
        return(true);
    if (str.substring(lat-1,lat)==dot || str.substring(lat+1,lat+2)==dot)
        return(true);
    if (str.indexOf(dot,(lat+2))==-1)
        return(true);
    if (str.indexOf(" ")!=-1)
        return(true);
    return (false);                 
}
</script>
</head>
<body>
<?php
    if (isset($_POST['submitted']))
    {
        echo (treat_submission());
        unset ($_POST['submitted']);
    }
    else
        echo (show_form());
?>
</body>
</html>

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$txt .= "<tr><td align=\"center\" ><font color=red><sup>*</sup></font><input type=\"checkbox\" value=\"0\" name=\"agree\"> Elfogadom az általános szerződési feltételeket! </td></tr>";