[% PROCESS "header.tt" title => "Pick Domain" %]

(Your ip is [% remote_addr %]) (The time is [% time %])

<form name=[% form_name %] action=[% script_name %] method=post>

<label>Pick a domain:</label>
<input type=text name=domain>
<input type=submit value="Check"><br>
<span class=error id=domain_error>[% domain_error %]</span>

</form>
[% js_validation %]

[% PROCESS "footer.tt" %]