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<form method="post"><input name="days" value="ТУТ ID с той формы" dir=ltr style="width:300px; height:16px" class="f_input" readonly><br />
<input name="price" value="ТУТ PRICE с той формы" dir=ltr style="width:300px; height:16px" class="f_input" readonly><br />
<input name="days" value="ТУТ DAYS с той формы" dir=ltr style="width:300px; height:16px" class="f_input" readonly><br />
<input type="text" value="" name="code" />
<input type="submit" name="add" value="Добавить" /></form>