<div class="formArea">
    <fieldset>
        <legend>{BLOCKED_DOMAIN_LEGEND}</legend>
        <table class="formFields" cellspacing="0" width="100%">
            <tr {NAME_ERROR}>
                <td class="name"><label for="fid-name">{NAME_TEXT}</label>&nbsp;{REQ}</td>
                <td><input type="text" name="name" id="fid-name" value="{NAME_VALUE}"></td>
            </tr>
        </table>
    </fieldset>
</div>
