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+<!-- $Id$ -->
+<form action="[% action || c.uri_for() %]" method="POST">
+<input type="hidden" name="hostinfo" value="1">
+<table border=0>
+<tr><th>Country</th>
+<td>
+<select name="country">
+<option value=""></option>
+[% FOREACH country = c.model('Mirrors').country_list %]
+<option value="[% country.code %]" [% "selected=select" IF country.code == host.country %]>[% country.name | html %]</option>
+[% END %]
+</select>
+</td>
+</tr>
+
+<tr><th>City</th>
+<td>
+<input type="text" name="city" value="[% host.city | html %]">
+</td>
+</tr>
+
+[% FOREACH mirror = c.model('Mirrors').find_mirrors %]
+[% IF loop.first %]
+<tr><th>Synchronized from</th>
+<td>
+<select name="syncfrom">
+<option value="">Unknown</option>
+[% END %]
+[% IF mirror.public %]
+<option value="[% mirror.hostname | html %]" [% "selected=select" IF host.syncfrom == mirror.hostname %]>[% mirror.hostname | html %]</option>
+[% END %]
+[% IF loop.last %]
+</select>
+</td>
+</tr>
+[% END %]
+[% END %]
+<tr><th>Approximated bandwidth</th>
+<td>
+<select name="bandwidth">
+<option value=""></option>
+[% FOREACH bd = c.model('Mirrors').bandwidth_list %]
+<option value="[% bd.value %]" [% "selected=select" IF host.bandwidth == bd.value %]>[% bd.name | html %]</option>
+[% END %]
+</select>
+</td>
+</tr>
+</table>
+<input type="submit">
+</form>