@header@

<form method=post action=@form_action_target@>
<table>
<tr>
 <th align=right>Name:</th>
 <td align=left><input name="name" value="@name@"></td>
</tr>
<tr>
 <th align=right>Creation Comment:</th>
 <td align=left><input size=30 name="creation_comment"></td>
</tr>
<tr>
 <th align=right>Active Status:</th>
 <td align=left>@active_p_select@</td>
</tr>
<tr>
 <td>&nbsp;</td>
 <td><input type=submit value="Add User Agent"></td>
</tr>
</table>
</form>

@footer@