<div id="qode_shortcode_form_wrapper">
<form id="qode_shortcode_form" name="qode_shortcode_form" method="post" action="">
	<div class="input">
		<label>Title</label>
		<input name="title" id="title" value="" maxlength="100" size="55" />
	</div>
	<div class="input">
		<label>Subtitle</label>
		<input name="subtitle" id="subtitle" value="" maxlength="100" size="55" />
	</div>
	<div class="input">
		<label>Price</label>
		<input name="price" id="price" value="" maxlength="100" size="12" />
	</div>
	<div class="input">
		<label>Currency</label>
		<input name="currency" id="currency" value="" maxlength="100" size="12" />
	</div>
	<div class="input">
		<label>Price Period</label>
		<input name="price_period" id="price_period" value="" maxlength="100" size="12" />
	</div>
	<div class="input">
		<label>Button 1 Text</label>
		<input name="button_text" id="button_text" value="" maxlength="100" size="12" />
	</div>
	<div class="input">
		<label>Link for button 1</label>
		<input name="link" id="link" value="" maxlength="100" size="55" />
	</div>
	<div class="input">
		<label>Target for button 1</label>
		<select name="target" id="target">
			<option value=""></option>
			<option value="_self">Self</option>
			<option value="_blank">Blank</option>
			<option value="_parent">Parent</option>
		</select>
	</div>
	<div class="input">
		<label>Button 2 Text</label>
		<input name="button_text2" id="button_text2" value="" maxlength="100" size="12" />
	</div>
	<div class="input">
		<label>Link for button 2</label>
		<input name="link2" id="link2" value="" maxlength="100" size="55" />
	</div>
	<div class="input">
		<label>Target for button 2</label>
		<select name="target2" id="target2">
			<option value=""></option>
			<option value="_self">Self</option>
			<option value="_blank">Blank</option>
			<option value="_parent">Parent</option>
		</select>
	</div>
	<div class="input">
		<label>Active</label>
		<select name="active" id="active">
			<option value=""></option>
			<option value="no">no</option>
			<option value="yes">yes</option>
		</select>
	</div>
	<div class="input">
		<input type="submit" name="Insert" id="qode_insert_shortcode_button" value="Submit" />
	</div>
</form>
</div>