ipreg/tpl/locationadd.tpl

<form method="POST" action="location.php">

<table class="title">
<tr>
    <td class="header">
        <img class="icon" src="images/building.png" alt="" />
        {$lang_location_add}
    </td>
    <td align="right">
        <a href="#" onClick="history.go(-1)"><img src="images/rewind.png" alt="{$lang_cancel}"{if $suser_tooltips}  title="{$lang_cancel}"{/if}></a>
        <input type="image" name="submit[insert]" src="images/save.png" alt="{$lang_submit}"{if $suser_tooltips}  title="{$lang_submit}"{/if}>
    </td>
</tr>
</table>

<table class="info">
<tr>
    <td class="header">
        {$lang_location}
    </td>
    <td class="header_right">
        &nbsp;
    </td>
</tr>
<tr>
    <td class="label">
        {$lang_location_name}
    </td>
    <td class="value">
        <input type="text" name="location_name">
    </td>
</tr>		
<tr>
    <td class="label">
        {$lang_location_info}
    </td>
    <td class="value">
        <textarea name="location_info" cols="30" rows="10"></textarea>
    </td>
</tr>
</table>

<table class="info">
<tr>
    <td class="header">
        {$lang_location_parent}
    </td>
    <td class="header_right">
        &nbsp;
    </td>
</tr>
<tr>
    <td class="label">
        {$lang_location_name}
    </td>
    <td class="value">
        {html_options name=location_parent options=$location_options selected=$location_parent}
    </td>
</tr>
</table>

</form>