<form action='$SELF_URL' METHOD='POST'>
<input type=hidden name=index value=$index>
<input type=hidden name=MAIL_DOMAIN_ID value=%MAIL_DOMAIN_ID%>
<table>
<tr><td>$_DOMAIN:</td><td><input type=text name=DOMAIN value='%DOMAIN%'></td></tr>
<tr><td>$_DISABLE:</td><td><input type=checkbox name=DISABLE value='1' %DISABLE%></td></tr>
<tr><th colspan=2>:$_COMMENTS:</th></tr>
<tr><th colspan=2><textarea name=COMMENTS cols=40 rows=5>%COMMENTS%</textarea></th></tr>
</table>
<input type=submit name=%ACTION% value='%LNG_ACTION%'>
</form>