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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
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<div class="jform">		
	<table class="jform">
	<tr>
	<td>
		<h2>Заказ доставки карт</h2>
		<form name="jform" action="/index.php/component/jforms/submit/3" method="post" enctype="multipart/form-data" onsubmit="return validateForm_3(this);">
					<div class='error-message' id='hcf10_257_error'></div>
		<label class='jftextbox' id='hcf10_257_label' for='hcf10_257' style='width:108px;height:22px;'>Адрес доставки:<span class="required" style="color:red"> * </span></label> 
		<input type='text' maxlength='50' class='jftextbox' value='' name='hcf10' id='hcf10_257' style='width:266px;height:18px;' />
		<div class="clear"></div>
		<div class='error-message' id='h4d8e_258_error'></div>
		<label class='jftextbox' id='h4d8e_258_label' for='h4d8e_258' style='width:108px;height:22px;'>Телефон:<span class="required" style="color:red"> * </span></label> 
		<input type='text' maxlength='16' class='jftextbox' value='' name='h4d8e' id='h4d8e_258' style='width:266px;height:18px;' />
		<div class="clear"></div>
		<div class='error-message' id='h3268_259_error'></div>
		<fieldset class='jfcheckbox' id='h3268_259' style='width:396px;height:194px;'>
		<legend class="jfcheckbox" id="h3268_259_label">Выберите карту (ы):<span class="required" style="color:red"> * </span></legend>
			<input  class='radio' value='400р (доставляются только по 2 карты)' id='h3268_259_0' name='h3268[]' type='checkbox' />
			<label class='radio' for='h3268_259_0'>400р (доставляются только по 2 карты)</label>
			<br />
			<input  class='radio' value='600р' id='h3268_259_1' name='h3268[]' type='checkbox' />
			<label class='radio' for='h3268_259_1'>600р</label>
			<br />
			<input  class='radio' value='900р' id='h3268_259_2' name='h3268[]' type='checkbox' />
			<label class='radio' for='h3268_259_2'>900р</label>
			<br />
			<input  class='radio' value='1200р' id='h3268_259_3' name='h3268[]' type='checkbox' />
			<label class='radio' for='h3268_259_3'>1200р</label>
			<br />
			<input  class='radio' value='1500р' id='h3268_259_4' name='h3268[]' type='checkbox' />
			<label class='radio' for='h3268_259_4'>1500р</label>
			<br />
		</fieldset>
		<div class="clear"></div>
<div class='jfhtml'><p>Стоимость доставки КАЖДОЙ карты- 30р.</p></div>		<div class='error-message' id='h1e74_261_error'></div>
		<label class='jftextarea' for='h1e74_261' id='h1e74_261_label' for='h1e74' style='width:110px;height:24px'>Доп. информация:</label> 
		<textarea rows='0' cols='0' class='jftextarea' name='h1e74' id='h1e74_261' style='width:266px;height:128px;'></textarea>
		<div class="clear"></div>
		<div class='error-message' id='h7cd4_262_error'></div>
		<script type='text/javascript'>
			var RecaptchaOptions = {
				theme : 'blackglass',
				lang : 'ru'
			};
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		<input name='h52b4' class='jfbutton' type='submit' value='Отправить' style='width:198px;height:32px;' />
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<div class='jfhtml'><p><span style="color: #c0c0c0;">Поля отмеченные звездочками (<span style="color: #ff0000;">*</span>) обязательны для заполнения!</span></p></div>		<input type='hidden' value='' name='ha821' id='ha821_265' />
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			<input type="hidden" name="Itemid" value="23" />
			<input type="hidden" name="82b8255c1b9fd79ed806971f16059318" value="1" />		</form>
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