<div class='page-header'>
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<h1><tmpl_var name="list_head_txt"></h1>
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</div>
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<p><tmpl_var name="list_desc_txt"></p>
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<div class="form-group">
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<label for="server_id" class="col-sm-3 control-label">{tmpl_var name='server_id_txt'}</label>
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<div class="col-sm-9"><select name="server_id" id="server_id" class="form-control">
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{tmpl_var name='server_id'}
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</select></div>
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</div>
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<div class="form-group">
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<label for="table" class="col-sm-3 control-label">{tmpl_var name='table_txt'}</label>
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<div class="col-sm-9"><select name="table" id="table" class="form-control">
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{tmpl_var name='table'}
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</select></div>
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</div>
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<div class="form-group">
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<label for="protocol" class="col-sm-3 control-label">{tmpl_var name='protocol_txt'}</label>
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<div class="col-sm-9"><select name="protocol" id="protocol" class="form-control">
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{tmpl_var name='protocol'}
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</select></div>
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</div>
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<div class="form-group">
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<label for="singleport" class="col-sm-3 control-label">{tmpl_var name='singleport_txt'}</label>
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<div class="col-sm-9"><input type="text" name="singleport" id="singleport" value="{tmpl_var name='singleport'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="multiport" class="col-sm-3 control-label">{tmpl_var name='multiport_txt'}</label>
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<div class="col-sm-9"><input type="text" name="multiport" id="multiport" value="{tmpl_var name='multiport'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="destination_ip" class="col-sm-3 control-label">{tmpl_var name='destination_ip_txt'}</label>
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<div class="col-sm-9"><input type="text" name="destination_ip" id="destination_ip" value="{tmpl_var name='destination_ip'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="source_ip" class="col-sm-3 control-label">{tmpl_var name='source_ip_txt'}</label>
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<div class="col-sm-9"><input type="text" name="source_ip" id="source_ip" value="{tmpl_var name='source_ip'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="state" class="col-sm-3 control-label">{tmpl_var name='state_txt'}</label>
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<div class="col-sm-9"><input type="text" name="state" id="state" value="{tmpl_var name='state'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="target" class="col-sm-3 control-label">{tmpl_var name='target_txt'}</label>
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<div class="col-sm-9"><select name="target" id="target" class="form-control">
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{tmpl_var name='target'}
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</select></div>
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</div>
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<div class="form-group">
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<label class="col-sm-3 control-label">{tmpl_var name='active_txt'}</label>
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<div class="col-sm-9">
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{tmpl_var name='active'}
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</div>
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</div>
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<input type="hidden" name="id" value="{tmpl_var name='id'}">
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<div class="clear"><div class="right">
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<button class="btn btn-default formbutton-success" type="button" value="{tmpl_var name='btn_save_txt'}" data-submit-form="pageForm" data-form-action="admin/iptables_edit.php">{tmpl_var name='btn_save_txt'}</button>
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<button class="btn btn-default formbutton-default" type="button" value="{tmpl_var name='btn_cancel_txt'}" data-load-content="admin/iptables_list.php">{tmpl_var name='btn_cancel_txt'}</button>
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</div></div>
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