<form action="sentmessage.php" method="POST" >

<dl>
    <div class="pt10">

                    <b style="margin-right:20px;">Ilość:</b>
                    <select class="fs-130" style="padding: 0px; width:150px;" name="opcja1">
<option value="">Nie chcę zamówić!</option>
                                                <option value="1c">40 ())</option>
                                                <option value="2c">100 ()</option>
                                                <option value="3c">300  ()</option>
                                            </select>
                    </div>
    <div class="pt10">

                    <b style="margin-right:20px;">Ilość:</b>
                    <select class="fs-130" style="padding: 0px; width:150px;" name="opcja2">
<option value="">Nie chcę zamówić!</option>
                                                <option value="1c">40 ())</option>
                                                <option value="2c">100 ()</option>
                                                <option value="3c">300  ()</option>
                                            </select>
                    </div>

    <div class="pt10">

                    <b style="margin-right:20px;">Ilość:</b>
                    <select class="fs-130" style="padding: 0px; width:150px;" name="opcja3">
<option value="">Nie chcę zamówić!</option>
                                                <option value="1c">40 ())</option>
                                                <option value="2c">100 ()</option>
                                                <option value="3c">300  ()</option>
                                            </select>
                    </div>
    <div class="pt10">

                    <b style="margin-left:50px;">Wpisz kod :</b>
                <br><input name="tresc" style="margin-left:56px; width:150px; box-sizing: border-box; height:32px" data-maxsize="16" data-output="status1" wrap="virtual"
type="text"
dir="rtl" />
        <span class="hint">Podaj kod.<span class="hint-pointer"> </span></span>
        
             <br />
  <div id="status1" style="width:250px;font-weight:bold;text-align:right"></div><br>
  
  
    
                </div>
    <dt class="button"> </dt>

    <dd class="button">
        <input type="submit" name="submit" value="Złóż zamównienie!" />
    </dd>
</dl>
</form>