pay.tpl
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<form enctype="multipart/form-data" style="padding:0px; margin:0px;" id="form_login" method="POST" onsubmit="
{literal}
if(jQuery('#pole1').val()==''){alert('Íå ââåäèíî ïîëå: «ÔÈλ');return false;}
if(jQuery('#pole3').val()==''){alert('Ñóììà ïëàòåæà');return false;}
if(jQuery('#pole4').val()==''){alert('Äàòà ïëàòåæà');return false;}
if(jQuery('#pole5').val()==''){alert('Âðåìÿ ïëàòåæà');return false;}
if(jQuery('#pole6').val()==''){alert('Íîìåð êâèòàíöèè');return false;}
if(jQuery('#pole7').val()==''){alert('Ââåäèòå êîä óêàçàííûé íà êàðòèíêå');return false;}
{/literal}
" action="#">
<input type="hidden" name="fuckoff" value="1">
<input type="hidden" name="send_info" value="1">
<div class="quickview" id="qv_view-all_1" style="border-radius:5px;display:none;background-color:#ffffff;width:750px;height:1040px;">
<div class="inner" style="font-size:14px;background-color:#ffffff;margin-left:30px;width:700px;height:940px;text-align:left;">
<a href="#" style="background: url('/img/close2.png') no-repeat scroll left top transparent;display: block;height: 35px;position: absolute;right: 21px;top: 21px;width: 32px;" class="close"><!-- --></a>
<div style="margin-right:60px;">
<div class="space"> </div>
<div class="space"> </div>
<h2 style="color:#378d1e;font-size:22px;">{$smarty.const.sbcModal_a}</h2>
<div class="space"> </div>
<div class="space"> </div>
<div>{$smarty.const.TEXTT1}</div>
<div class="space"> </div>
<div>
{$smarty.const.TEXTT2}
</div>
<div class="space"> </div>
<div style="padding:30px;background-color:#f5f5f5;">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB1}</label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 170px; padding-left: 5px;" name="form[nom_zakaza]" value="">
<div class="space"> </div>
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB2}<font color="red">*</font></label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 440px; padding-left: 5px;" id="pole1" name="form[fio]" value="">
<div class="space"> </div>
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB3}</label><br/>
<table width="100%" cellspacing="0" cellpadding="0">
<tr>
<td>
<input type="file" id="pole2" style="" name="img"></td><td width="100%" style="padding-left:10px;">(gif, jpeg, jpg, bmp)</td></tr></table>
</div>
<div style="padding:30px;">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB4}</label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 440px; padding-left: 5px;" name="form[adress]" value="">
<div class="space"> </div>
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB5}<font color="red">*</font></label><br/>
<table width="100%" cellspacing="0" cellpadding="0">
<tr>
<td>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 170px; padding-left: 5px;" id="pole3" name="form[summ]" value="">
</td><td style="padding-left:10px;">
{$smarty.const.TEXTT4}
</td></tr></table>
<div class="space"> </div>
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB6}</label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 380px; padding-left: 5px;" name="form[bank]" value="">
<div class="space"> </div>
<table width="646px" cellspacing="0" cellpadding="0">
<tr>
<td align="left" width="33%">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB7}<font color="red">*</font></label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 170px; padding-left: 5px;" name="form[date]" id="pole4" value="">
</td>
<td align="left" width="33%">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB8}<font color="red">*</font></label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 170px; padding-left: 5px;" name="form[time]" id="pole5" value="">
</td>
<td align="left" width="33%">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB9}<font color="red">*</font></label><br/>
<input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 170px; padding-left: 5px;" name="form[nom]" id="pole6" value="">
</td>
</tr>
</table>
<div class="space"> </div>
<table width="646px" cellspacing="0" cellpadding="0">
<tr>
<td align="left">
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB10}</label><br/>
<textarea type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 130px; width: 380px; padding-left: 5px;" name="form[b33]"></textarea>
</td><td width="100%" align="center" valign="bottom">
<div>{*<img src="/antibot.php" />*}</div><br/>
<label style="color:#388e1f;font-size:14px;">{$smarty.const.TB11}<font color="red">*</font></label><br/>
<div><span style="color:#388e1f;font-size:18px;">5+2=</span><input type="text" style="border-radius:5px 5px 5px 5px; font-size: 14px; border: 3px solid rgb(203, 203, 203); height: 32px; width: 150px; padding-left: 5px;" name="b44" id="pole7"></div><br/>
<input type="submit" value="{$smarty.const.SUBSEND}">
</td></tr></table>
</div>
</div>
</div>
</div>
</form>