<div class='page-header'>
	<h1><tmpl_var name="list_head_txt"></h1>
</div>
<p><tmpl_var name="list_desc_txt"></p>


        <legend>IP Address</legend>
            <div class="form-group">
                <label for="server_id" class="col-sm-3 control-label">{tmpl_var name='server_id_txt'}</label>
                <div class="col-sm-9"><select name="server_id" id="server_id" class="form-control">
                    {tmpl_var name='server_id'}
                </select>
            </div></div>
            <div class="form-group">
                <label for="client_id" class="col-sm-3 control-label">{tmpl_var name='client_id_txt'}</label>
                <div class="col-sm-9"><select name="client_id" id="client_id" class="form-control">
                    {tmpl_var name='client_id'}
                </select>
            </div></div>
            <div class="form-group">
                <label for="ip_type" class="col-sm-3 control-label">{tmpl_var name='ip_type_txt'}</label>
                <div class="col-sm-9"><select name="ip_type" id="ip_type" class="form-control">
                    {tmpl_var name='ip_type'}
                </select>
            </div></div>
            <div class="form-group">
                <label for="ip_address" class="col-sm-3 control-label">{tmpl_var name='ip_address_txt'}</label>
                <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>
            <div class="form-group">
                <label class="col-sm-3 control-label">{tmpl_var name='virtualhost_txt'}</label>
                <div class="col-sm-9">
                    {tmpl_var name='virtualhost'}
                </div>
            </div>
            <div class="form-group">
                <label for="virtualhost_port" class="col-sm-3 control-label">{tmpl_var name='virtualhost_port_txt'}</label>
                <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>
        
            
        <input type="hidden" name="id" value="{tmpl_var name='id'}">
            
        <div class="clear"><div class="right">
            <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>
            <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>
        </div></div>