<h1>Форма обратной связи</h1><div class="fanpreload">
	
	<p align="center">
	
      
		<center>
		<form action="/otzivi?act=sended" method="post"  onsubmit="return checkmyform(this)" enctype="multipart/form-data" class="" >
		<input type="hidden" name="form_ident" value="emailer1" />	
		
    	<div id='d-' title=''  class="obform  "  ><div id='d-Vyibe4430' title=''  class="obform  "  ><div  title='~Vyibe4430' class='i_t need '><table align='center' width='100%' >
	<tr>
	<td align='left' style='padding-bottom:0;' valign='top'>Выберете желаемую дату.(*)<span class="red">*</span>:</td></tr><tr>
	<td align='left' valign='top' class='it_input'><input type='text'  id='Vyibe4430' name='Vyibe4430'  class='' value='' style='width:100%' /> 
		</td> 	
	
	
	</tr>
	</table></div>
		</div><div id='d-email' title=''  class="obform  "  ><div  title='~email' class='i_t need '><table align='center' width='100%' >
	<tr>
	<td align='left' style='padding-bottom:0;' valign='top'>E-mail<span class="red">*</span>:</td></tr><tr>
	<td align='left' valign='top' class='it_input'><input type='text'  id='email' name='email'  class='' value='' style='width:100%' /> 
		</td> 	
	
	
	</tr>
	</table></div>
		</div><div id='d-tel' title=''  class="obform  "  ><div  title='~tel' class='i_t need '><table align='center' width='100%' >
	<tr>
	<td align='left' style='padding-bottom:0;' valign='top'>Телефон<span class="red">*</span>:</td></tr><tr>
	<td align='left' valign='top' class='it_input'><input type='text'  id='tel' name='tel'  class='' value='' style='width:100%' /> 
		</td> 	
	
	
	</tr>
	</table></div>
		</div><div id='d-message' title=''  class="obform  "  ><div  title='~message' class='i_t need '><table align='center' width='100%' >
	<tr>
	<td align='left' style='padding-bottom:0;' valign='top'>Сообщение<span class="red">*</span>:</td></tr><tr>
	<td align='left' valign='top' class='it_input'><textarea type='text' rows='6' name='message' style='width:100%' class='' >###textarea###
		</td> 	
	
	
	</tr>
	</table></div>
		</div>
		</div>	
		<div id="itogo" class="red"></div>	
		<input type="hidden" name="valsumm" value="" id="valsumm"/>	
                <table class="cpc"  >
                	<tr>
					  
					  <td align="center"><div style="position:relative;margin:auto;width:140px;margin:5px 0;"><a style="position:absolute;" class="reload" onclick="reloadcapcha(this)" ></a><img src='/jscripts/c.php?0.272698' alt=""
	  /></div></td>
					</tr>
					<tr>
					  <td align="center">Введите символы с картинки:</td></tr>
					 <tr>
					  <td align="center"><input style="width:100%" type="text" name="secretcode" value="" /></td>
					</tr>
					<tr>
					  <td  align="center" valign="middle" ></td>
					  </tr>
				</table>
				<input type="hidden" name="page" value="42" />
				<div class="outotpravit"><div class="mess" ></div><input  class="otpravit ibut_fonts_stand" type="submit" name="web_form_submit" value="Отправить" /></div>
				</form>
	</center> 
            </div>