{{include file="field_input.tpl" field=$piwikbaseurl}}
{{include file="field_input.tpl" field=$siteid}}
{{include file="field_checkbox.tpl" field=$optout}}
{{include file="field_checkbox.tpl" field=$async}}
{{include file="field_checkbox.tpl" field=$shortendpoint}}
<div class="submit"><input type="submit" name="page_site" value="{{$submit}}" /></div>
