I have a simple form and i need to convert it to work in DotNetNuke.   Can anyone help convert this to work in a simple HTML module?

<form method="POST" action="https://www.merchante-solutions.com/jsp/tpg/secure_checkout.jsp">
<input type="text" name="transaction_amount" size="4">
<input type="hidden" name="profile_id" value="9410000xxxxx000000xx">
<input type="hidden" name="logo_url" value="http://www.example.com/images/example.png">
<input type="hidden" name="return_url" value="http://www.example.com/return.html">
<input type="hidden" name="cancel_url" value="http://www.example.com/cancel.html">
<input type="hidden" name="css_url" value="http://www.example.com/default.css">
<input type="hidden" name="invoice_number" value="123456">
<input type="submit" value="Donate Now"> </form>