+<% include('/elements/header.html', "$action $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 %>">
+
+<INPUT TYPE="radio" NAME="action" VALUE="N"<% $kludge_action eq 'N' ? ' CHECKED' : '' %>>New
+<BR>
+
+<INPUT TYPE="radio" NAME="action" VALUE="M"<% $kludge_action eq 'M' ? ' CHECKED' : '' %>>Transfer
+
+<P>Domain <INPUT TYPE="text" NAME="domain" VALUE="<% $domain %>" SIZE=28 MAXLENGTH=63>
+
+<BR>Purpose/Description: <INPUT TYPE="text" NAME="purpose" VALUE="<% $purpose %>" SIZE=64>
+
+<P><INPUT TYPE="submit" VALUE="Submit">
+
+</FORM>
+
+<% include('/elements/footer.html') %>
+
+<%init>
+
+die "access denied"
+ unless $FS::CurrentUser::CurrentUser->access_right('Provision customer service'); #something else more specific?