index.html

<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>Tracking Example</title>
</head>
<body>

    <form method="post" action="" data-conversion="Loginfield"  data-fields="{'user': 'username', 'pass': 'password'}">
        <input type="text" name="username" id="username" placeholder="Username" />
        <input type="password" name="password" id="password" placeholder="Password" />
        <input type="submit" value="submit" />
    </form>

    <script>
        var settings = {
            phsrid: 13245,
            mailingid: 1,
            anonymizeip: false,
            phsrserver: "http://phsr-backend.de"
        };

        (function(p, h, s, r) {
            r=p.createElement(s);r.src=h;p.body.appendChild(r);
        })(document, 'http://phsr-backend.de/src/tracking.js', 'script');
    </script>
</body>
</html>