<div class="wm_bg">
<span class="wm_title">Пожертвовать</span>
<span class="wm_sum">руб.</span>
<form action='wmk:payto' method='get'>
<input name='Purse' value="R352370119298" type='hidden' />
<input name='Amount' value='100' size='8' type='text' class="wm_input" /> <input type='submit' value="" class='wm_fbutton' />
<input name='Desc' value='' type='hidden' />
<input name='BringToFront' value='Y' type='hidden' />
</form>
</div>

.wm_bg{
  background: url(http://webo4ka.ru/Ucoz4/poproshajka_wmr_bg_wm.png) no-repeat;
  width: 224px;
  height: 77px;
  position: relative;
}
.wm_fbutton{
  display: block;
  background: url(http://webo4ka.ru/Ucoz4/poproshajka_wmr_input_wm.png) no-repeat 0 0;
  position: absolute;
  left: 5px;
  top: 0;
  width: 85px;
  height: 71px;
  border: 0;
  cursor: pointer;
}
.wm_fbutton:hover{
  background-position: 0 -71px;
}
.wm_input{
  border: 0;
  position: absolute;
  right: 39px;
  top: 41px;
  height: 22px;
  width: 80px;
  line-height: 22px;
  color: #95401a;
  font-weight: bold;
  font-family: Tahoma;
  font-size: 11px;
  padding-left: 5px;
  background: transparent;
}
.wm_title{
  color: #95401a;
  font-family: Tahoma;
  font-size: 11px;
  display: block;
  position: absolute;
  left: 100px;
  top: 22px;
}
.wm_sum{
  color: #fff;
  font-family: Tahoma;
  font-size: 11px;
  display: block;
  position: absolute;
  left: 190px;
  top: 54px;
}
.wm_bg form{
  padding: 0;
  margin: 0;
}
.wm_bg input{
  outline: none;
}