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

    <tr>
      <td colspan='3' rowspan='17'><div align='center'></div></td>
      <td colspan='4'><span class='style6'>Fields with <span style="color: red">*</span> are mandatory</span></td>

</tr>
<tr>
<td></td>
<td colspan='3'></td>
</tr>
<tr>
<td></td>
<td colspan='3' style="padding-top:10px;"><strong>BOOK ACQUISUITION REQUEST</strong></td>
</tr>
<tr>
<td></td>
<td colspan='3'></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>User 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'>Name:</div></td>
<td colspan='2'><input type='text' name='name_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Phone:</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'>Science degree/duty:</div></td>
<td colspan='2'><input type='text' name='duty_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Faculty:</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>Author:</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>Title:</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'>Place of publishing:</div></td>
<td colspan='2'><input type='text' name='place_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'>Publisher:</div></td>
<td colspan='2'><input type='text' name='publisher_form' SIZE=37/></td>
<td></td>
</tr>
<tr>
<td width='220'><div align='left'><span style="color: red">*</span><strong>Year of publishing:</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'>ISBN:</div></td>
<td colspan='2'><input type='text' name='ISBN_form' SIZE=37/></td>
<td></td>
</tr>
 

<tr>
<td><div align='left'><span style="color: red">*</span><strong>Enter four times the number 'eight' (use only numbers from the keyboard)</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='SUBMIT'/>
      <td width='122'><input type='Reset'  name='resetbtn' value='CLEAR' >
      <td width='102'>

      <td></td>
    </tr>
    
      

     
  </table>
</form>
 
 
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