<!DOCTYPE html>
<html>
<head>
<title>Formulario</title>
</head>
<body>
<form action="http://domain.co/email/index.php/lists/jw518ag5y4385/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>
</body>
</html>