copy the below code
to the autoresponder section at instantsqueezepagegenerator
<table
border=0 bgcolor=#CCCCCC>
<tr><td>
<table border=0
cellpadding=15 width=97% bgcolor=#EEEEEE>
<tr><td>
<form
action="http://www.sendfree.com/arform.cgi" method="POST">
<input
type="hidden" name="type" value="1">
<input type="hidden" name="id"
value="128740">
<table border=0 cellpadding=0
cellspacing=0>
<tr><td
align=right>Name:</td><td><input type="text"
name="name"></td></tr>
<tr><td
align=right>Email:</td><td><input type="text"
name="email"></td></tr>
<tr><td>
</td><td><input type="submit" name="submit"
value="Submit">
<p><font size=-1> Powered by <a
href="http://www.sendfree.com/affref.php3?ref=105573">Sendfree</a></font></td></tr>
</table>
</td></tr>
</table>
</td></tr>
</table>
</form>