form.html

<form action="" method="post">
        <input type="hidden" name="csrfmiddlewaretoken" value="WjfP52q0v6yO9ME0Ookn1RvXeM93MMiYcXOP9D4KwatNXL0u9E5nqjj4nwirpz0O">
        <table>
            <tbody><tr><th><label for="id_due_back">Renewal date:</label></th><td><input id="id_due_back" name="due_back" type="text" value="2017-04-15"><br><span class="helptext">Enter a date between now and 4 weeks (default 3).</span></td></tr>
        </tbody></table>
        <input type="submit" value="Submit">
    </form>