<?php
echo '<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd"><html> <head>
<meta http-equiv="Content-type" content="text/html; charset=iso-8859-2">
<meta name="Description" content=" [wstaw tu opis strony] ">
<meta name="Keywords" content=" [wstaw tu slowa kluczowe] ">
<meta name="Author" content=" [dane autora] ">
<meta name="Generator" content="kED2">
<title> [tytuł strony] </title>
<link rel="stylesheet" href=" styl.css " type="text/css">
<link rel="stylesheet" href=" menu_style.css " type="text/css">
</head>
<body>
<center>
<script src="http://cdn.jotfor.ms/jotform.jgz?3.1.110" type="text/javascript"></script>
<script type="text/javascript">
JotForm.init();
</script>
<link href="http://cdn.jotfor.ms/jotform.cssgz?3.1.110" rel="stylesheet" type="text/css" />
<link type="text/css" rel="stylesheet" href="http://www.jotform.com/css/styles/baby_blue.css" />
<style type="text/css">
.form-label{
width:100px !important;
}
.form-label-left{
width:100px !important;
}
.form-line{
padding:10px;
}
.form-label-right{
width:100px !important;
}
.form-all{
width:332px;
color:Black !important;
font-family:Arial;
font-size:14px;
}
</style>
<form class="jotform-form" action="zarejestrowano.php" method="post" name="form_11763141263" id="11763141263" accept-charset="utf-8">
<div class="form-all">
<ul class="form-section">
<li id="cid_1" class="form-input-wide">
<div class="form-header-group">
<h2 id="header_1" class="form-header">
Logowanie
</h2>
</div>
</li>
<input type="hidden" name="refer" value="' . $_GET['ref'] . '"/>
<li class="form-line" id="id_4">
<label class="form-label-left" id="label_4" for="input_4">
Login<span class="form-required">*</span>
</label>
<div id="cid_4" class="form-input"><span class="form-sub-label-container"><input type="text" class="form-textbox validate[required]" id="input_4" name="q4_login4" size="20" />
<label class="form-sub-label" for="input_4"> Twój login </label></span>
</div>
</li>
<li class="form-line" id="id_5">
<label class="form-label-left" id="label_5" for="input_5">
Hasło<span class="form-required">*</span>
</label>
<div id="cid_5" class="form-input">
<input type="password" class="form-textbox validate[required]" id="input_5" name="q5_haslo" size="20" />
</div>
</li>
<li class="form-line" id="id_8">
<label class="form-label-left" id="label_8" for="input_8">
E-mail<span class="form-required">*</span>
</label>
<div id="cid_8" class="form-input"><span class="form-sub-label-container"><input type="email" class="form-textbox validate[required, Email]" id="input_8" name="q8_email" size="20" />
<label class="form-sub-label" for="input_8"> np. email@mail.pl </label></span>
</div>
</li>
<li id="cid_7" class="form-input-wide">
<div class="form-header-group">
<h2 id="header_7" class="form-header">
Dane do wysyłki
</h2>
</div>
</li>
<li class="form-line" id="id_9">
<label class="form-label-left" id="label_9" for="input_9">
Imię<span class="form-required">*</span>
</label>
<div id="cid_9" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_9" name="q9_imie" size="20" />
</div>
</li>
<li class="form-line" id="id_10">
<label class="form-label-left" id="label_10" for="input_10">
Nazwisko<span class="form-required">*</span>
</label>
<div id="cid_10" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_10" name="q10_nazwisko" size="20" />
</div>
</li>
<li class="form-line" id="id_11">
<label class="form-label-left" id="label_11" for="input_11">
Ulica<span class="form-required">*</span>
</label>
<div id="cid_11" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_11" name="q11_ulica" size="20" />
</div>
</li>
<li class="form-line" id="id_12">
<label class="form-label-left" id="label_12" for="input_12">
Nr mieszkania<span class="form-required">*</span>
</label>
<div id="cid_12" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_12" name="q12_nrMieszkania" size="20" />
</div>
</li>
<li class="form-line" id="id_13">
<label class="form-label-left" id="label_13" for="input_13">
Miasto<span class="form-required">*</span>
</label>
<div id="cid_13" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_13" name="q13_miasto" size="20" />
</div>
</li>
<li class="form-line" id="id_14">
<label class="form-label-left" id="label_14" for="input_14">
Poczta<span class="form-required">*</span>
</label>
<div id="cid_14" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_14" name="q14_poczta" size="20" />
</div>
</li>
<li class="form-line" id="id_15">
<label class="form-label-left" id="label_15" for="input_15">
Kod pocztowy<span class="form-required">*</span>
</label>
<div id="cid_15" class="form-input">
<input type="text" class="form-textbox validate[required]" id="input_15" name="q15_kodPocztowy" size="20" />
</div>
</li>
<li class="form-line" id="id_2">
<div id="cid_2" class="form-input-wide">
<div style="text-align:right" class="form-buttons-wrapper">
<button id="input_2" type="submit" class="form-submit-button">
Rejestracja
</button>
</div>
</div>
</li>
<li style="display:none">
Should be Empty:
<input type="text" name="website" value="" />
</li>
</ul>
</div>
<input type="hidden" id="simple_spc" name="simple_spc" value="11763141263" />
<script type="text/javascript">
document.getElementById("si" + "mple" + "_spc").value = "11763141263-11763141263";
</script>
</form>
</center>
</body>
</html>';
?>