Webcollect - simple

<form action="http://portal.emailnetworks.com/wc/wc.cfm" name="subscribeForm" method="post" >
<table width=500 border=0 align="center" cellpadding=3 cellspacing=0 style="border: 2px solid #000000; padding: 8px;">
<tr><td> <img border="0" src="http://portal.emailnetworks.com/images/logo.jpg" /></td></tr>
<input type="hidden" name="thankyou" value="http://portal.emailnetworks.com/wc/thankyou.cfm">
<input type="hidden" name="err" value="http://portal.emailnetworks.com/wc/error.cfm">
<input type="hidden" name="Action" value="sub">
<input type="hidden" name="LID" value="123">
<input type="hidden" name="MID" value="123">
<tr>
  <td>
  <table width=500 border=0 align="center" cellpadding=3 cellspacing=0 style="border: 1px solid #cccccc; padding: 8px;">
          <tr> 
          <td align="center">You can subscribe to our mailing list by filling out the form below and clicking on the "Subscribe!" button.
          </td></tr>
          <tr>
            <td align="center"> <table width="100%" border="0" cellpadding="3" cellspacing="0">          
                   <tr> 
                  <td width="35%" align="right"><font color="#333333" face="Arial, Helvetica, sans-serif"><strong><font color="#990000">*</font>Email 
                    Address: </strong></font></td>
                  <td width="65%"><div align="left"><font face="Arial, Helvetica, sans-serif"> 
                      <input type="text" size="30" name="EmailAddress">
                      </font></div></td>
                </tr>

				<tr> 
                  <td colspan=3 width="100%" align="left">Please select your lists of interest</td>
                </tr>
				<tr> 
                  <td colspan=3 width="100%" align="left"><input type="checkbox" name="LID" id="2458387102" value="2458387102"> test list  12-18-12</td>
                </tr><tr><td colspan=3>   <p align="center"> <font face="Arial, Helvetica, sans-serif"> 
                      <input name="submit" type="submit" value="Subscribe!">
                      </font></p></td><tr>                 
              </table>
              </td>
          </tr>
        </table>
  </td>
</tr>
</table></form>