<style type="text/css">
    .subscription-form input {
        display: inline-block;
        padding: 4px;
        font-size: 13px;
        line-height: 18px;
        color: #555555;
        border: 1px solid #ccc;
        -webkit-border-radius: 3px;
        -moz-border-radius: 3px;
        border-radius: 3px;
        width: 100%;
        box-sizing: border-box;
        -moz-box-sizing: border-box;
        margin-bottom: 10px;
    }
    .checkbox_wrapper {
        display: inline-block;
        padding: 4px;
        width: 100%;
    }
    .subscription-form input.checkbox_type, .subscription-form .checkbox_label {
        width: auto;
        vertical-align: middle;
        margin-top: 0px;
        margin-bottom: 0px;
    }
    .subscription-form .checkbox_label {
        display: inline-block;
        line-height: 18px;
        margin-left: 4px;
        font-size: 12px;
        font-family: arial; 
        color: #ffffff;
    }

    .subscription-form input {
        color: #000000;
        background-color: #ffffff;
        border: 1px solid #c4c4c4;
        border-radius:  3px;
        -webkit-border-radius:  3px;
        -moz-border-radius:  3px;
    }

    .btn-grad {
        background: -webkit-linear-gradient(top,rgba(0,0,0,0) 0%,rgba(0,0,0,0.2) 100%);
        background: -o-linear-gradient(top,rgba(0,0,0,0) 0%,rgba(0,0,0,0.2) 100%);
        background: -moz-linear-gradient(top,rgba(0,0,0,0) 0%,rgba(0,0,0,0.2) 100%);
        background: linear-gradient(top,rgba(0,0,0,0) 0%,rgba(0,0,0,0.2) 100%);
    }

    .subscription-form-fields {
        margin-top: 15px;
    }

    .subscription-form {
        width: 250px; 
        border: 2px solid #e4d3d5; 
        border-radius: 10px; 
        padding: 20px; 
        margin: 0 auto; 
        background-color: #20040f;
    }

    .subscription-form h4 {
        font-family: arial; 
        color: #565656; 
        font-size: 20px;
        margin-top: 0px;
    }

    .subscription-thank-you {
        font-family: arial; 
        color: #ffffff; 
        font-size: 12px;
    }

    .subscription-form-content {
        font-family: arial; 
        color: #ffffff; 
        font-size: 12px;
    }

    .subscription-form button {
        margin-top: 5px; 
        border-radius: 5px; 
        padding: 10px; 
        display: block; 
        text-align: center;
        border: none;
        width: 100%;
        color: #ffffff; 
        background-color: #f11e28; 
        font-size: 20px; 
        font-family: helvetica;
    }

    .sender-sub-main {
        display: table;
        width: 100%;
        height: 100%;
    }

    .sender-sub-inner {
        display: table-cell;
        vertical-align: middle;
    }
    
    .sender-link-wrapper {
        display: block;
        position: relative;
        margin-top: 16px;
    }
    .sender-link {
        font-family: Arial, "Helvetica Neue", Helvetica, sans-serif;
        font-size: 12px;
        text-decoration: none !important;
        color: #555;
    }
    
    .sender-link img {
        width: 16px;
        height: 16px;
        margin-right: 2px;
        vertical-align: text-bottom;
    }

</style>
<div class="sender-sub-main">
    <div class="sender-sub-inner">
        <div class="subscription-form">
            <h4 class="dont-break-out"></h4>
                                        <div class="subscription-form-fields">
                    <div class="subscription-form-content">
                        <h3 style="text-align:center"><span style="color:#ecf0f1"><span style="font-size:16px"><strong>The New Sure-Fire Roadmap To Get Back The Lost Love Between You And Your Ex Lover.... Guaranteed!</strong></span></span></h3>

<p style="text-align:center"><br />
<span style="color:#ecf0f1">Kindly put your name and active email address in the fields below and click &ldquo;I Want The Report&rdquo;</span></p>
                    </div>
                    <form id="sender-subscribe" action="https://app.sender.net/forms/sender_subscription/11132/e6a16254" method="POST">
                                        
                            <div class="subscription-form-fields" id="subscription-form-fields">
                                                                                                        <input name="firstname" class="text_type" id="firstname" data-label="Name" placeholder="Name" required>
                                                                                                                                            <input name="email" type="email"class="email_type" id="email" data-label="Email" placeholder="Email" required>
                                                                                                </div>
                                                <button type="submit" class="btn-grad dont-break-out">I Want The Report</button>
                    </form>
                </div>
                                <span class="sender-link-wrapper">
                    <a class="sender-link" href="http://sender.net" title="Email marketing services">
                        <img src="https://app.sender.net/favicon.png">
                        <span>Sender.net email marketing</span>
                    </a>
                </span>
                                    </div>
    </div>
</div>                
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