<html> <form method="post" action="https://app.pipelinedeals.com/web_lead"> <!-- Required Hidden Fields --> <input type="hidden" name="w2lid" value="334lkn43kn5" /> <input type="hidden" name="thank_you_page" value="http://website.com/thankyou.html" /> <!-- Basic Demographic Fields --> <p><label>Name</label><br/> <input type="text" name="lead[full_name]"></p> <p><label>Company</label><br/> <input type="text" name="lead[company_name]"></p> <p><label>Phone</label><br/> <input type="text" name="lead[phone]"></p> <input type="text" name="lead[fax]"></p> <p><label>Email Address</label><br/> <input type="text" name="lead[email]"></p> <!-- Tags --> <p><label>Product</label><br /> <select name="tag_1"> <option value="Widget A">Widget A</option> <option value="Widget B">Widget B</option> </select> <!-- Comments Field --> <input type="hidden" name="note_title_1" value="User Comments" /> <textarea name="note_1"></textarea> <input type="submit" value="save" /> </form> </html>