<form method="post" action="http://yhst-144062776671280.stores.yahoo.net/cgi-bin/pro-forma">
    Your Name:<input type="text" name="Name"><br>
    Your Email:<input type="text" name="Email"><br>
    <input type="submit" value="Submit">
    <input name="Owner" value="nick@ureach-usa.com" type="hidden">
</form>