<div class="box box-primary">
<div class="box-header">
<h3 class="box-title">[LIST_NAME]</h3>
</div>

<div class="box-body">
<div class="callout callout-info">We're happy you decided to subscribe to our email list.<br />
Please take a few seconds and fill in the list details in order to subscribe to our list.<br />
You will receive an email to confirm your subscription, just to be sure this is your email address.</div>
[LIST_FIELDS]</div>

<div class="box-footer">
<div class="pull-right">[SUBMIT_BUTTON]</div>

<div class="clearfix"> </div>
</div>
</div>
