<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>
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</div></div>
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<div class="form-group">
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<label for="tcp_port" class="col-sm-3 control-label">{tmpl_var name='tcp_port_txt'}</label>
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<div class="col-sm-9"><input type="text" name="tcp_port" id="tcp_port" value="{tmpl_var name='tcp_port'}" class="form-control" /></div></div>
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<div class="form-group">
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<label for="udp_port" class="col-sm-3 control-label">{tmpl_var name='udp_port_txt'}</label>
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<div class="col-sm-9"><input type="text" name="udp_port" id="udp_port" value="{tmpl_var name='udp_port'}" class="form-control" /></div></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'}" onclick="submitForm('pageForm','admin/firewall_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/firewall_list.php">{tmpl_var name='btn_cancel_txt'}</button>
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</div></div>
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