<FORM NAME="setting" action="update_setting">
  <p>Port Number: 
    <input name="port_num" type="text" size="40" value='$PORT_NUM$'>
  </p>
<p>
    <input name="local_only" type="checkbox" value="checkbox" $LOCAL_ONLY$>
    Local Only</p>

  <p>
    <input type="submit" name="update_setting" value="Update Settings">
    <input type="submit" name="cancel_update_setting" value="Cancel">
    (NOTICE: changes will not take effect until restart.)</p>
</FORM>