</p><form action="https://merchant.webmoney.ru/lmi/payment.asp" method="post" name="bolshe"><span class="n"><center><input type="radio" name="chislo" value="1" checked="">Под Первым->
<img src="http://wmbingo.com/images/chest1.gif" width="100" height="116"><br><input type="radio" name="chislo" value="2">Под Вторым->
<img src="http://wmbingo.com/images/chest1.gif" width="100" height="116">
<center><span class="n">Размер ставки:
<select class="submit3" name="LMI_PAYMENT_AMOUNT">

<option value="0.05">0.05</option>
<option value="0.1">0.1</option>
<option value="0.2">0.2</option>
<option value="0.3">0.3</option>
<option value="0.4">0.4</option>
<option value="0.5">0.5</option>
<option value="0.7">0.7</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="5">5</option>
<option value="10">10</option>
<option value="20">20</option>
<option value="30">30</option>
</select>

<input type="hidden" name="num" value="11">
<input type="hidden" name="chislo" value="96">
<input type="hidden" name="p" value="ВАШ Z-КОШЕЛЁК">
<select name="LMI_PAYEE_PURSE" class="submit3">
<option value="Z200949580143">WMZ</option>

</select><br>
<input name="LMI_PAYMENT_DESC" type="hidden" value="Лотерея Сундучок Удачи">

<br>
<input name="submit2" type="submit" class="submit2" value="Играть!">

</span></center></center></span></form>