<form action="/!!!PATH!!!" method="post">
    <input type="text" name="!!!PARAMETER_NAME!!!" placeholder="!!!PARAMETER_DISPLAY_NAME!!!" value="!!!DEFAULT_VALUE!!!" class="text_field" style="width: 170px;"><br>
    <input type="submit" value="Set value" class="middle_button" style="margin-top: 5px; margin-bottom: 5px">
</form>