<form class="form-inline" method="POST" action="redirection/post">
<fieldset>
<legend>Create New Short Cut</legend>
<select id="domain" class="span2" name="domain" class="input-medium">
<?php foreach ($domains as $do): ?>
<option <?php echo ($do->domain == $_SERVER['HTTP_HOST']) ? 'selected="selected"' : '' ?>><?php echo $do->domain; ?></option>
<?php endforeach ?>
</select>
<label>/</label>
<input type="text" class="span3" id="path" name="path" placeholder="path" pattern="[A-Za-z0-9]*" required>
<div class="control-group">
<span class="help-block" id="help-path">What short cut would you like to create?</span>
</div>
<input type="text" class="span5" id="url" name="url" placeholder="URL" pattern="[^\s]*" required>
<span class="help-block" id="help-url">To point to which URL?</span>
<button type="submit" class="btn" disabled>Submit</button>
</fieldset>
<br/>
<legend>This domain may be for <a href="http://www.afternic.com/leenooks">sale</a>!</legend>
</form>
