Need quick HTML help w/squeeze page and opt in form

Well, I guess I missed connecting with source47;

Here's what I need: JUST enough of the right code to connect my own squeeze page's opt-in form to my autoresponder. Most autoresponders that I've seen what you build a form around the fields -- I don't want that, just the fields.

How 'bout if I post the part of the code from a current opt-in form I've got -- could someone just show me what is relevant? I'll have to strip out the links, but that shouldn't be a problem. (I can clearly see some things that aren't relevant -- border, padding, background, margin, etc. -- I just don't know how much I can delete, and what must stay in.)

Any help would be appreciated.

<form accept-charset="utf-8"
action="------ LINK REMOVED -------- /cgi-bin/add.cgi"
style="margin: 5px; width: 250px; font-family: verdana; background-color: rgb(255, 255, 255);"><input
name="custom_http_referer" id="custom_http_referer"
value="" type="hidden">
<div id="webform_title"
style="border: 1px solid rgb(39, 141, 226); padding: 7px 20px; line-height: 21px; font-size: 21px; color: rgb(255, 255, 255); background-color: rgb(39, 141, 226);">Please
send my Free Report </div>
<div
style="border: 1px solid rgb(222, 222, 222); font-family: tahoma;">
<div
style="padding: 16px 16px 12px; font-size: 12px; color: rgb(76, 75, 75);"></div>
<hr
style="border: 0pt none ; margin: 0pt 20px; height: 1px; background-color: rgb(240, 240, 240); color: rgb(240, 240, 240);">
<ul id="fields"
style="margin: 0pt; padding: 15px 30px; list-style-type: none; list-style-image: none; list-style-position: outside; font-size: 12px; color: rgb(123, 123, 123);">
<li id="subscriber_name-field"
style="margin: 0pt; padding: 4px 0pt 5px; background: transparent none repeat scroll 0% 50%; -moz-background-clip: initial; -moz-background-origin: initial; -moz-background-inline-policy: initial; width: 100%;">
<label style="float: left;"
for="subscriber_name">Name :</label>
<input
style="border: 1px solid rgb(174, 177, 134); float: right; width: 140px;"
id="subscriber_name" name="subscriber_name" value=""
type="text">
<div style="clear: both;"></div>
</li>
<li id="subscriber_email-field"
style="margin: 0pt; padding: 4px 0pt 5px; background: transparent none repeat scroll 0% 50%; -moz-background-clip: initial; -moz-background-origin: initial; -moz-background-inline-policy: initial; width: 100%;">
<label style="float: left;"
for="subscriber_email">Email :</label>
<input
style="border: 1px solid rgb(174, 177, 134); float: right; width: 140px;"
id="subscriber_email" name="subscriber_email" value=""
type="text">
<div style="clear: both;"></div>
</li>
</ul>
<ul
style="margin: 0pt; padding: 15px 30px; list-style-type: none; list-style-image: none; list-style-position: outside; font-size: 12px; color: rgb(123, 123, 123); text-align: center;">
</ul>
<input name="confirmation_url"
id="confirmation_url"
value="------ LINK REMOVED --------"
type="hidden"> <input
name="error_url" id="error_url" value=""
type="hidden"><input
name="campaign_name" id="campaign_name"
value="betterhealthnaturally" type="hidden"><input
name="custom_ref" id="custom_ref" value=""
type="hidden">
<hr
style="border: 0pt none ; margin: 0pt 20px; height: 1px; background-color: rgb(240, 240, 240); color: rgb(240, 240, 240);">
<div
style="text-align: center; padding-bottom: 18px; padding-top: 10px;"><input
id="webform_submit"
style="border: 0pt none ; margin: 10px; font-family: verdana; font-size: 18px; color: rgb(255, 255, 255); background-image: url("------PNG LINK REMOVED --------"); width: 140px; height: 33px;"
value="Submit" type="submit">
<div
style="color: rgb(0, 0, 255); margin-top: 10px; width: 100%; clear: both;">GetResponse
<a href=""------ LINK REMOVED --------"/">Email
Marketing</a></div>
<div class="clearer"></div>
</div>
</div>
</form>
</div>
<script type="text/javascript">var el=document.getElementById("custom_http_referer"); if(el != null){el.value = document.location};</script>
</div>
<br>
<br>
<br>
</body>
</html>