<form action="http://<?php print $server;?>/confirm" method = "POST" id="mnf" name="mnf">
<fieldset>
<label>Ф. И. О.</label>
<div class="form_in_in">
<input type = "text" name = "fio"/>
</div>
</fieldset>
<fieldset>
<label>Телефон:</label>
<div class="form_in_in">
<input type = "text" name = "phone1"/>
</div>
</fieldset>
<fieldset>
<label>Компания:</label>
<div class="form_in_in">
<input type="text" name="company"/>
</div>
</fieldset>
<fieldset>
<label>Запрос:</label>
<div class="form_in_in">
<textarea name="text"></textarea>
</div>
</fieldset>
<fieldset>
<div class="form_in_in">
<div class="button_alt_holder"><div class="button_alt"> <input type="submit" value="Отправить"/> <i> </i></div></div>
</div>
</fieldset>
</form>