{% if form_id == "monthly" %}

        <input type="hidden" name="cmd" value="_xclick-subscriptions">

        <input type="hidden" name="no_note" value="1">

        <input type="hidden" name="t3" value="M">

        <input type="hidden" name="p3" value="1">

        <input type="hidden" name="src" value="1">

        <label for="a3">Monthly Amount: </label>

        <div class="input-group">

        $ <input type="number" name="a3" size="5" tabindex="10"

               min="{{ min_amt }}" value="{{ default_amt }}">

        {% else %}

        <input type="hidden" name="cmd" value="_xclick">