radio_group(-name=>['add_remove'],
		    -values=>['Add','Remove'],
		    -default=>'Add',
		    -labels=>\%labels),p,


##</code><code>##

"Rule: ",em(param('add_remove')),p,

##</code><code>##

#!/usr/bin/perl -w
use CGI qw/:standard/;
print 
 	header,
       	start_html('Service Request Form'),
       	h1('Service Request Form'),
       	start_form,
       	"Name:<br>",textfield('name'),p,
	"Phone:<br>",textfield('phone'),p,
	"Date:<br>",textfield('date'),p,
       	"Email:<br>",textfield('email'),p,


	"Add or Remove this rule",
	"<br>",


	radio_group(-name=>['add_remove'],
		    -values=>['Add','Remove'],
		    -default=>'Add',
		    -labels=>\%labels),p,

	"Source:<br>",textfield('source'),p,	
	"Destination:<br>",textfield('destination'),p,
	"Service:<br>",textfield('service'),p,

	"What do you want to happen to this traffic?",
	"<br>",
	

	radio_group(-name=>['action'],
		    -values=>['Accept','Reject'],
		    -default=>'Accept',
	            -labels=>\%labels),p,

	"Please describe what you are trying to accomplish:<br>",
	textarea(-name=>'description',
		 -rows=>10,
		 -columns=>50),p,

       	submit,
       	end_form,
       	hr,"\n";
if (param)	{
       	print 
	        "Name ",em(param('name')),p,

			"Phone Number: ",em(param('phone')),p,

			"Date: ",em(param('date')),p,           

			"Email: ",em(param('email')),p,

			"Rule: ",em(param('add_remove')),p,

			"Source: ",em(param('source')),p,

			"Destination: ",em(param('destination')),p,

			"Service: ",em(param('service')),p,

			"Action: ",em(param('action')),p,

			"Description: ",em(param('description')),p,		

       		}
print end_html;