<form action="http://smartflee.com/mailwizz/index.php/lists/pt8179mrohd6a/subscribe" method="post" accept-charset="utf-8" target="_blank">

<div class="form-group">
<label>Email <span class="required">*</span></label>
<input type="text" class="form-control" name="EMAIL" placeholder="" value="" required />
</div>

<div class="form-group">
<label>First name</label>
<input type="text" class="form-control" name="FNAME" placeholder="" value=""/>
</div>

<div class="form-group">
<label>Last name</label>
<input type="text" class="form-control" name="LNAME" placeholder="" value=""/>
</div>

    <div class="clearfix"><!-- --></div>
    <div class="actions">
    <button type="submit" class="btn btn-primary btn-flat">Subscribe</button>
    </div>
    <div class="clearfix"><!-- --></div>

</form>