text" name="c_11" class="form-control" placeholder="11"/>
              </div>
              <div class="form-group">
                  <input type="text" name="c_26" class="form-control" placeholder="26"/>
              </div>
            </div>
            <div class="form-inline">
              <div class="form-group">
                  <input type="text" name="c_46" class="form-control" placeholder="46"/>
              </div>
              <div class="form-group">
                  <input type="text" na