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<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script><script src="https://sendiio.com/assets/js/form_assets.js"></script><h1>GrooveFunnels New Form</h1><div class="rendered-form"></div><form class="form-horizontal" method="post" action="https://sendiio.com/callbacks/subscription/lists"><br><input type="text" class="form-control" id="name" name="name"  value="" placeholder="Your Name" required><br><input type="email_name" class="form-control" id="email" name="email"  value="" placeholder="Your Email" required><input type="hidden" name="list" id="list" value="21279"><br><input type="hidden" name="form" value="4813"><br><button type="submit" class="btn btn-default edit-form" id="save_form">Submit</button></form><br><br>