document.write('<form method="POST" action="request.php">');
document.write('  <input type="hidden" id="place" name="place" value=""/>');
document.write('  <p style="color:#800000;font-size:8pt;font-family:Tahoma;">Заявка на поиск офиса без комиссии</p>');
document.write('    <div style="text-align:center;color:#373737;font-weight:bold;">Станция метро</div>');

    document.write('<select style="width:90%;" id="place_list" onchange="document.getElementById(\'place\').value=this.options[this.selectedIndex].text;">');
    build_select();
    document.write('</select>');
    document.getElementById('place').value=current_page(document.getElementById('place_list'));

document.write('    <div style="text-align:center;color:#373737;font-weight:bold;">Телефон и контактное лицо</div>');
document.write('    <input style="width:90%;" type="text" name="contacts"/>');
document.write('    <div style="text-align:center;color:#373737;font-weight:bold;">Описание требуемого офиса</div>');
document.write('  <textarea style="width:90%;" name="text"></textarea>');
document.write('  <input style="width:45%;" type="submit" name="submit" value="Отправить"/>');
document.write('  <input style="width:45%;" type="reset" name="reset" value="Сброс"/>');
document.write('</form>');