<form action="options.php" method="post">
    <input name="option_page" type="hidden" value="sa_theme_options" />
    <input name="action" type="hidden" value="update" />
    <input id="_wpnonce" name="_wpnonce" type="hidden" value="a8c5892f9d" />
    <input name="_wp_http_referer" type="hidden" value="/wordpress/wp-admin/themes.php?page=theme_options" />
    <table class="form-table">
        <tr class="options_input options_text">
            <th><span class="labels"><label for="sa_options[sa_headerfontsize]">
            Title Font Size</label></span></th>
            <td>
            <input id="sa_options[sa_headerfontsize]" class="small-text" name="sa_options[sa_headerfontsize]" type="text" value="" /></span></td>
            <td><span class="description">Set the size of the blog title font in
            pixels. E.g. to set the size as 55 pixels just put 55 in the box. Can
            be useful if you have a long title and want it to fit on one line.</span></td>
        </tr>
        <tr class="options_input options_text">
            <th><span class="labels"><label for="sa_options[sa_bannerimage]">Title
            Banner Image</label></span></th>
            <td>
            <input id="sa_options[sa_bannerimage]" class="" name="sa_options[sa_bannerimage]" type="text" value="" /></span></td>
            <td><span class="description">Enter the URL of your image banner to
            be displayed in the header. This will replace the blog title and description.</span></td>
        </tr>
    </table>
    </table>
    <p><input class="button-primary" type="submit" value="Save Options" /></p>
</form>