<form action="http://pro.betwext.com/subscribe/v1/b726988797ebf22a526822ab6585bbd1" method="post" id="signup_form">
<div>
<label for="btwxp_phone">Phone:</label><br><input type="text" name="btwxp_phone" id="btwxp_phone"><br>
<label for="btwxp_email">Email:</label><br><input type="text" name="btwxp_email" id="btwxp_email"><br>
<label for="btwxp_name">Name:</label><br><input type="text" name="btwxp_name" id="name"><br>
<input type="submit" value="Subscribe">
</div>
</form>