Info stranica

Treba mi .html stranica (moze i php il ostali jezik ne smeta) slijedeca:

Da neko ukuca u nju:

Ime i Prezime:
Datum narudzbe:
Uplaceni iznos: ( )KM (ovo zagrada znaci pored mjesta za ukucavanje da stoji KM)
Zeljeni artikal:

Naravno pored svega ovoga da stoji mjesto za kucanje .

Eh, treba mi kad neko to ukuca, i pritisne submit, potrvdi il sta vec stavite, da mi dodje na mail il PM tog sajta.

Dizajn: Crno i Bijelo izmijesano, masti na volju.

a tvoj mail je?

Probaj ovo nez jel dobro samo c/p u notepad i sacuvaj kao ime.html .

<html>
<head>
<title>Narudzba</title>
<meta http-equiv="Content-Type" content="text/html;

charset=windows-1250">
</head>
<body bgcolor="#FFFFFF" text="#000000">
<p><b>Narudzba </b></p>
<hr>
<div align="left"><b>Lične informacije:</b> </div>
<form name="info" method="post" action="">
<table width="600" border="0" cellspacing="1"

cellpadding="1">
<tr>
<td>Ime:</td>
<td><input type="text" name="ime"></td>
<td>Prezime:</td>
<td><input type="text" name="prezime"></td>
</tr>
<tr>
<td>atum Narudzbe:</td>
<td><input type="text" name="ulica" size="30"></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>Grad:</td>
<td><input type="text" name="grad" value="Sarajevo"></td>
<td>ržava:</td>
<td>
<select name="drzava">
<option>Bosna i Hercegovina</option>
<option>Srbija i Crna Gora</option>
<option>Mađarska</option>
<option>Hrvtaska</option>
<option>Kosovo</option>
<option>Slovenija</option>
</select>
</td>
</tr>
<tr>
<td>Poštanski broj:</td>
<td><input type="text" name="postBroj" size="5"

maxlength="5"></td>
<td>&nbsp;</td>
<td>&nbsp; </td>
</tr>
<tr>
<td rowspan="2">Pol:</td>
<td>Muški <input type="radio" name="pol" value="pol">

</td>
<td rowspan="2">&nbsp;</td>
<td rowspan="2">&nbsp;</td>
</tr>
<tr>
<td>Ženski <input type="radio" name="pol" value="pol"

checked></td>
</tr>
</table>
</td>
</tr>
<tr>
<td>Uplaceni iznos:</td>
<td><input type="password" name="Uplaceni Iznos"></td>
<td>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td>Vasa poruka poslodavcu : :</td>
<td><textarea cols="30" rows="5">Ovdje staviti artikle i

kolicinu.</textarea></td>
<td><input type="hidden" name="skriveno" value="OVO JE

SKRIVENO POLJE"></td>
<td>&nbsp;</td>
</tr>
<tr>
<td colspan="6">
<div align="center">
<input type="submit" name="potvrdi" value="POTVRDI">
<input type="reset" name="odustani" value="ODUSTANI">
</div>
</td>
</tr>
</table>
</form>
</body>
</html>