Before I even post...I am not very "literate" with coding...

I have created text/html module with a form in it that "should" submit information to our ExactTarget account. This form is only collecting simple data (first name, last name, email address). We are not enabling buttons that need feed information from ExactTarget back to our site.

I cannot for the life of me get the form to work...any suggestions? Again, I am VERY new to all this so below is some of the language I have in the module for you to review. THANK IN ADVANCE for any assistance!!!

<form action="http://cl.exct.net/subscribe.aspx?lid=XXXXXOUR#HERE" method="post" name="subscribeform">
    <input type="hidden" name="MID" value="XXXOUR#HERE" />
    <table cellspacing="0" cellpadding="0" border="0">
        <tbody>
            <tr>
                <td><font face="Verdana" size="2">First Name:</font></td>
                <td><input name="First Name" type="text" /></td>
            </tr>
            <tr>
                <td><font face="Verdana" size="2">Last Name:</font></td>
                <td><input name="Last Name" type="text" /></td>
            </tr>
            <tr>
                <td><font face="Verdana" size="2">Company Name:</font></td>
                <td><input name="Company" type="text" /></td>
            </tr>
            <tr>
                <td><font face="Verdana" size="2">Email:</font></td>
                <td><input name="Email Address" type="text" /></td>
            </tr>
            <tr>
                <td>&#160;</td>
            </tr>
            <tr>
                <td><input type="hidden" checked="checked" name="SubAction" value="sub_add_update" /></td>
            </tr>
            <tr>
                <td><input type="submit" value="Submit" /></td>
                <td align="right">&#160;</td>
            </tr>
        </tbody>
    </table>
</form>