<?php include_once("settings.php"); ?>
<form method="post" action="index.php?page=adauga-in-db" enctype="multipart/form_data">
<table style="width: 80% text-align:center; padding:8px;">
   	<tr>
	   <td style="pading: 8px;">Alege agent:&nbsp; 
		   <select name="01">
				<option value="Agent 01" selected>Agent 01</option>
				<option value="Agent 02" >Agent 02</option>
				<option value="Agent 03" >Agent 03</option>
				<option value="Agent 04" >Agent 04</option>
				<option value="Agent 05" >Agent 05</option>
				<option value="Agent 06" >Agent 06</option>
				<option value="Agent 07" >Agent 07</option>
				<option value="Agent 08" >Agent 08</option>
				<option value="Agent 09" >Agent 09</option>
				<option value="Agent 10" >Agent 10</option>
				<option value="Agent 11" >Agent 11</option>
				<option value="Agent 12" >Agent 12</option>
				<option value="Agent 13" >Agent 13</option>
				<option value="Agent 14" >Agent 14</option>
				<option value="Agent 15" >Agent 15</option>
				<option value="Agent 16" >Agent 16</option>
				<option value="Agent 17" >Agent 17</option>
				<option value="Agent 18" >Agent 18</option>
				<option value="Agent 19" >Agent 19</option>
				<option value="Agent 20" >Agent 20</option>
				<option value="Agent 21" >Agent 21</option>
				<option value="Agent 22" >Agent 22</option>
				<option value="Agent 23" >Agent 23</option>
				<option value="Agent 24" >Agent 24</option>
				<option value="Agent 25" >Agent 25</option>
			</select>
		</td>
</tr>
<tr>
	<td>Defineste client nou:&nbsp;
		<select name="02">
			<option value="S.C. " selected>S.C.</option>
			<option value="A.F. ">A.F.</option>
			<option value="P.F. ">P.F.</option>
			<option value="I.I. ">I.I.</option>
		</select>
	&nbsp;<input name="03" value="" required size="40">
		<select name="04">
			<option value=" S.R.L." selected>S.R.L.</option>
			<option value=" S.C.S.">S.C.S.</option>
			<option value=" S.A.">S.A.</option>
			<option value="  ">Nimic</option>
		</select>
	</td>
</tr>
	<tr>
		<td>
			CUI (CIF) :
			<input name="cui" value="" type="number" size="20"> (fara RO)
		</td>
	</tr>
		<td><center>Observatii :<br><textarea name="1000" rows="8" cols="60"></textarea></center></td>
  </tr>
  <tr>
    <td><center><input name="submit" type="submit" id="submit" value="Adauga client"></center></td>
  </tr>
  </table>
</form>
  