<form action="{form_action}" method="POST">
 <table border="0" width="50%" align="center">
  <tr>
   <td colspan="2" bgcolor="{th_bg}">&nbsp;{header_message}</td>
  </tr>

  <tr bgcolor="{row_on}">
   <td>{lang_name}</td>
   <td><input name="value" value="{name_value}"></td>
  </tr>

  <tr>
   <td align="right" colspan="2"><input type="submit" name="submit" value="{submit_value}"></td>
  </tr>
 </table>
</form>
