Seedlip

<!-- Form elements go here: Style as you wish -->

<table>
	<tr>
		<th>Email address</th>
		<td>
			<input name="ue" type="text" value="" />
		</td>
	</tr>
	<tr>
		<th>First name</th>
		<td>
			<input name="firstname" type="text" value="" />
		</td>
	</tr>
	<tr>
		<th>Last name</th>
		<td>
			<input name="lastname" type="text" value="" />
		</td>
	</tr>
	<tr>
		<th>City Of Residence</th>
		<td>
			<input name="properties.city_of_residence" type="text" value="" />
		</td>
	</tr>
</table>
<input type="submit" value="Submit form" style="padding: 5px 20px;" name="submit" />

<!-- End of form elements -->