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<table style="padding: 20px;"><tr><td>
<h2>Please fill in the form:</h2>
<form action="%%=RequestParameter('PAGEURL')=%%" method="post">
<label>First name: </label><input type="text" name="firstname" required=""><br>
<label>Last name: </label><input type="text" name="lastname" required=""><br>
<label>Company: </label><input type="text" name="company" required=""><br>
<label>Email: </label><input type="text" name="email" required=""><br>
<input name="submitted" type="hidden" value="true"><br>
<input type="submit" value="Submit">
</form>
</td></tr></table>
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