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<HEAD><TITLE> </TITLE>
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</HEAD>
<script type="text/javascript">
function newin(location, w, h, scr) {
window.open(location, '', 'width='+w+', height='+h+', scrollbars='+scr+', top='+((screen.height / 4)-(h / 2))+', left='+((screen.width / 4) - (w / 2)));
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<BODY bgproperties=fixed background=images/index_11.jpg LINK="C0C0C0" VLINK="C0C0C0" ALINK="C0C0C0" LEFTMARGIN=0 TOPMARGIN=0 MARGINWIDTH=0 MARGINHEIGHT=0>
<CENTER>
<BR>
<table >
<tr>
<td>
<form action="mail.php" method="post"><CENTER>
<table width=240>
<tr><td>
<input type="text" name="name">
</B></FONT>
</td><td>
<FONT face="Tahoma" size=2 COLOR="400040" >ùí
</td>
<tr><td>
<input type="text" name="id">
</B></FONT>
</td><td>
<FONT face="Tahoma" size=2 COLOR="400040" >ú.æ
</td>
<tr><td>
<input type="text" name="phone">
</B></FONT>
</td><td>
<FONT face="Tahoma" size=2 COLOR="400040" >èìôåï
</td>
<tr><td>
<input type="text" name="city">
</B></FONT>
</td><td>
<FONT face="Tahoma" size=2 COLOR="400040" >òéø îâåøéí
</td>
<tr><td>
<input type="text" name="money">
</B></FONT>
</td><td>
<FONT face="Tahoma" size=2 COLOR="400040" >ñëåí äìååàä
</td>
<tr><td><P ALIGN=RIGHT>
<SELECT NAME="tashlumim">
<OPTION value="1">1</OPTION>
<OPTION value="2">2</OPTION>
<OPTION value="3">3</OPTION>
<OPTION value="4">4</OPTION>
<OPTION value="5">5</OPTION>
<OPTION value="6" selected>6</OPTION>
</SELECT>
</B></FONT>
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<FONT face="Tahoma" size=2 COLOR="400040" >úùìîéí
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</form>
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