<table width="100%" style="height: 100%" border="0" cellpadding="0" cellspacing="0">
<tr>
<td align="center" valign="top">
<form id="form1" name="form1" method="post" action="submitmail.php?language=bg">
<table width="100%" border="0" cellspacing="0" cellpadding="2">
<tr>
<td width="250" align="left" bgcolor="#29333D" class="text"><span class="style1"><strong>Данни за наемане</strong></span></td>
<td colspan="2" align="left" bgcolor="#29333D" class="text"> </td>
</tr>
<tr>
<td width="250" align="left" class="text"><label><span class="style4">* Модел автомобил:</span></label></td>
<td colspan="2" align="left" class="text"><select name="model" class="form_back" id="model">
<option selected="selected">Моля изберете ...</option>
<option>Opel Zafira 2007 Automatic</option>
<option>Chevrolet Lacetti 2007 Automatic</option>
<option>Opel ASTRA Classic</option>
<option>Opel Zafira</option>
<option>Opel Vivaro</option>
<option>Opel Vectra</option>
<option>Opel Astra 2007</option>
<option>Chevrolet Captiva Automatic</option>
<option>Opel Corsa</option>
<option>Volkswagen Polo</option>
<option>Chevrolet Evanda Automatic</option>
<option>Seat Leon CDTI</option>
</select></td>
</tr>
<tr>
<td width="250" align="left" class="style4">* Дата на вземане:</td>
<td colspan="2" align="left" class="text"><select name="day" class="form_back" id="day">
<option>ден</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
</select>
<select name="month" class="form_back" id="month">
<option>месец</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
</select>
<select name="year" class="form_back" id="year">
<option>година</option>
<option>2011</option>
<option>2012</option>
</select>
</td>
</tr>
<tr>
<td width="250" align="left" class="style4">* Дата на връщане:</td>
<td colspan="2" align="left" class="text"><select name="day2" class="form_back" id="day2">
<option>ден</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
<option>13</option>
<option>14</option>
<option>15</option>
<option>16</option>
<option>17</option>
<option>18</option>
<option>19</option>
<option>20</option>
<option>21</option>
<option>22</option>
<option>23</option>
<option>24</option>
<option>25</option>
<option>26</option>
<option>27</option>
<option>28</option>
<option>29</option>
<option>30</option>
<option>31</option>
</select>
<select name="month2" class="form_back" id="month2">
<option>месец</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
<option>7</option>
<option>8</option>
<option>9</option>
<option>10</option>
<option>11</option>
<option>12</option>
</select>
<select name="year2" class="form_back" id="year2">
<option>година</option>
<option>2011</option>
<option>2012</option>
</select></td>
</tr>
<tr>
<td width="250" align="left" class="text"> </td>
<td colspan="2" align="left" class="text"> </td>
</tr>
<tr>
<td width="250" align="left" class="style4">Допълнителни възможности:</td>
<td colspan="2" align="left" class="text"><label><input name="foreign" type="checkbox" class="form_back" id="foreign" />
<span class="style4">Наем за чужбина</span></label></td>
</tr>
<tr>
<td width="250" align="left" class="text"> </td>
<td colspan="2" align="left" class="text"> </td>
</tr>
<tr>
<td width="250" align="left" bgcolor="#29333D" class="text"><span class="style1"><strong>Данни за наемателя</strong></span></td>
<td colspan="2" align="left" bgcolor="#29333D" class="text"> </td>
</tr>
<tr>
<td width="250" align="left" class="style4">* Име:</td>
<td colspan="2" align="left" class="text"><input name="name" type="text" class="form_back" id="name" size="35" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">* Фамилия:</td>
<td colspan="2" align="left" class="text"><input name="family" type="text" class="form_back" id="family" size="35" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">Адрес:</td>
<td colspan="2" align="left" class="text"><input name="address" type="text" class="form_back" id="address" size="35" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">* Телефон :</td>
<td colspan="2" align="left" class="text"><input name="tel" type="text" class="form_back" id="tel" size="35" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">* е-mail:</td>
<td colspan="2" align="left" class="text"><input name="mail" type="text" class="form_back" id="mail" size="35" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">Допълнителна информация:</td>
<td colspan="2" align="left" class="text"><textarea name="additional" cols="35" rows="4" class="form_back" id="additional"></textarea></td>
</tr>
<tr>
<td width="250" align="left" class="style4">Въведете кода от картинката:</td>
<td width="75" align="left" class="text"><input name="co" type="text" class="form_back" size="10" /></td>
<td width="163" align="left" class="text"><img src='capt.php' alt="" /></td>
</tr>
<tr>
<td width="250" align="left" class="style4">Полетата отбелязани с * са задължителни!</td>
<td colspan="2" align="left" class="text style1"><input name="submit" type="submit" class="form_back" id="submit" value="Изпрати запитване" /></td>
</tr>
</table>