{$start_form}
<div class="form_row">
   <span class="field_title">{$title_description}</span>
   <span class="field_input">{$input_description}</span>
</div>
<div class="form_row">
   <span class="field_title">{$title_explanation}</span>
   <span class="field_input">{$input_explanation}</span>
</div>
<div class="form_row">
   <span class="field_title"></span>
   <span class="field_input">{$submit}</span>
</div>
{$end_form}