<html>
<head><title>Page with form that targets an insecure URL</title>
</head>
<body>
  <form action='https://REPLACE_WITH_HOST_AND_PORT/google.html' id='theform' method='post'>
    <input type='text' id='textfield' name='fieldname' value='fieldvalue'>
    <input type='submit' id='submit' value='submit'>
  </form>
</body>
</html>