< form method="post" action="https://almed.tshinc.com/MDSWEB/login904" > < input name="CustomerId" type="text" placeholder="Username" /> < input name="password" type="password" placeholder="Password"> < input type="submit" name="submitbutton" value="Login" > < input type="hidden" name="pageid" value="0"> < input type="hidden" name="loginpath" value="OE"> < /form>