
<form method='post'>
  <p align='center'></p>
  <table width='100%' border='0'>

    <tr>
      <td colspan='3' rowspan='19'><div align='center'></div></td>
      <td colspan='4'><span class='style6'>Полетата със <span style="color: red">*</span> са задължителни</span></td>

</tr>
<tr>
<td></td>
<td colspan='3'></td>
</tr>
<tr>
<td></td>
<td colspan='3' style="padding-top:10px;"><strong>ПОРЪЧКА НА СТАТИЯ ИЛИ ЧАСТ ОТ КНИГА</strong></td>
</tr>
<tr>
<td></td>
<td colspan='3'></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Потребителско ID:</strong></div></td>
<td colspan='2'><input type='text' name='userid_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Име, презиме, фамилия: </div></td>
<td colspan='2'><input type='text' name='name_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Телефон за връзка: </div></td>
<td colspan='2'><input type='text' name='phone_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Е-mail:</strong></div></td>
<td colspan='2'><input type='text' name='email_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Научна степен/длъжност:</div></td>
<td colspan='2'><input type='text' name='duty_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Факултет:</div></td>
<td colspan='2'><input type='text' name='faculty_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Автор на статията:</strong></div></td>
<td colspan='2'><input type='text' name='author_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Заглавие на статията:</strong></div></td>
<td colspan='2'><input type='text' name='title_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Заглавие на периодично издание:</strong></div></td>
<td colspan='2'><input type='text' name='titleper_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>ISSN:</div></td>
<td colspan='2'><input type='text' name='ISSN_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Том:</strong></div></td>
<td colspan='2'><input type='text' name='vol_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Година на издаване:</strong></div></td>
<td colspan='2'><input type='text' name='year_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Номер на книжка:</div></td>
<td colspan='2'><input type='text' name='BookNum_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Страници:</div></td>
<td colspan='2'><input type='text' name='pages_form' SIZE=37/></td>
<td></td>
</tr>
 

<tr>
<td><div align='left'><span style="color: red">*</span><strong>Въведете четири осмици</strong></div></td>
<td colspan='2'><input type='text' name='not_robot' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td colspan='7'><div align='center'></div></td>
</tr>
<tr>
<td></td>
<td></td>
<td></td>
<td></td>
<td width='263'><input type='SUBMIT' name="gogogo" value='ИЗПРАТИ'/>
      <td width='122'><input type='Reset'  name='resetbtn' value='ИЗЧИСТИ' >
      <td width='102'>

      <td></td>
    </tr>
    
      

     
  </table>
</form>
 
 
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