  <div class="form-group">
	<input type="hidden" id="id2" value=" " />
    <label for="exampleInputEmail1">Tag Host</label>
    <input type="domain" class="form-control" id="tag" value=" " >
  </div>
  <div class="form-group">
	<input type="hidden" id="id2" value=" " />
    <label for="exampleInputEmail1">Domain/IP</label>
    <input type="domain" class="form-control" id="ip" value=" " >
  </div>
  <div class="form-group">
    <label for="exampleInputPassword1">Port</label>
    <input type="number" class="form-control" id="port2" value=" ">
  </div>

   <div class="form-group">
	 	<label for="timeout">timeout</label>
	 	<select id="timeout">
  		<option value="on">ON</option>
  		<option value="off">OFF</option> 
		</select>
		
		<label for="lblset">lblset</label>
	 	<select id="lblset">
  		<option value="on">ON</option>
  		<option value="off">OFF</option> 
		</select>
		
		<label for="route">route</label>
	 	<select id="route">
  		<option value="on">ON</option>
  		<option value="off">OFF</option> 
		</select>
		
		<label for="loadfactor">loadfactor</label>
	 	<select id="loadfactor">
  		<option value="on">ON</option>
  		<option value="off">OFF</option> 
		</select>
		
		<label for="status">status</label>
	 	<select id="status">
  		<option value="on">ON</option>
  		<option value="off">OFF</option> 
		</select>
   </div>	
	 