<form action="********.ru/admin/add.php" method="POST" style="margin-left: 30px; margin-top: 10px;">
               <input value="" class="inputform" placeholder="ФИО*" name="family1" style="width: 340px;" required="" type="text">
               <input value="" class="inputform" placeholder="Телефон*" name="phone" style="width: 340px;" required="" type="text">

               Количество:

                  <select class="styled rightcolumn" id="amount" name="count" style="margin: 5px;">
                            <option selected="" value="1">1шт - 200руб.</option>
                            <option value="2">2шт - 380руб.</option>
                            <option value="3">3шт - 510руб.</option>
                            <option value="4">4шт - 640руб.</option>
                            <option value="5">5шт - 750руб.</option>
                           
                        </select>
                Доставка по Крыму 100р.
                    
               
               <input class="redbutton" style="float: right; margin: 0px 25px 15px 0px; padding: 0px 83px; height: 50px; width: 355px;" value="заказать сейчас!" type="submit">
      <input name="action" value="1" type="hidden">
            </form>