-my($svcnum, $pkgnum, $svcpart, $kludge_action, $purpose, $part_svc,
+<% include('/elements/error.html') %>
+
+<FORM ACTION="<% $p1 %>process/svc_domain.cgi" METHOD=POST>
+<INPUT TYPE="hidden" NAME="svcnum" VALUE="<% $svcnum %>">
+<INPUT TYPE="hidden" NAME="pkgnum" VALUE="<% $pkgnum %>">
+<INPUT TYPE="hidden" NAME="svcpart" VALUE="<% $svcpart %>">
+
+<% ntable("#cccccc",2) %>
+<TR>
+<P>Domain <INPUT TYPE="text" NAME="domain" VALUE="<% $domain %>" SIZE=28 MAXLENGTH=63>
+<BR>
+% if ($export) {
+Available top-level domains: <% $export->option('tlds') %>
+</TR>
+
+<TR>
+<INPUT TYPE="radio" NAME="action" VALUE="N"<% $kludge_action eq 'N' ? ' CHECKED' : '' %>>Register at <% $registrar->{'name'} %>
+<BR>
+
+<INPUT TYPE="radio" NAME="action" VALUE="M"<% $kludge_action eq 'M' ? ' CHECKED' : '' %>>Transfer to <% $registrar->{'name'} %>
+<BR>
+
+<INPUT TYPE="radio" NAME="action" VALUE="I"<% $kludge_action eq 'I' ? ' CHECKED' : '' %>>Registered elsewhere
+
+</TR>
+
+% }
+
+<TR>
+<P><INPUT TYPE="submit" VALUE="Submit">
+</TR>
+</TABLE>
+</FORM>
+
+<% include('/elements/footer.html') %>
+
+<%init>
+
+die "access denied"
+ unless $FS::CurrentUser::CurrentUser->access_right('Provision customer service'); #something else more specific?
+
+my($svcnum, $pkgnum, $svcpart, $kludge_action, $part_svc,