<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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<legend>IP Address</legend>
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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="client_id" class="col-sm-3 control-label">{tmpl_var name='client_id_txt'}</label>
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<div class="col-sm-9"><select name="client_id" id="client_id" class="form-control">
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{tmpl_var name='client_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="ip_type" class="col-sm-3 control-label">{tmpl_var name='ip_type_txt'}</label>
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<div class="col-sm-9"><select name="ip_type" id="ip_type" class="form-control">
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{tmpl_var name='ip_type'}
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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="ip_address" class="col-sm-3 control-label">{tmpl_var name='ip_address_txt'}</label>
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<div class="col-sm-9"><input type="text" name="ip_address" id="ip_address" value="{tmpl_var name='ip_address'}" 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='virtualhost_txt'}</label>
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<div class="col-sm-9">
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{tmpl_var name='virtualhost'}
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</div>
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</div>
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<div class="form-group">
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<label for="virtualhost_port" class="col-sm-3 control-label">{tmpl_var name='virtualhost_port_txt'}</label>
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<div class="col-sm-9"><input type="text" name="virtualhost_port" id="virtualhost_port" value="{tmpl_var name='virtualhost_port'}" class="form-control" /></div></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/server_ip_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/server_ip_list.php">{tmpl_var name='btn_cancel_txt'}</button>
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</div></div>
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