</div>
</div>
+ <div class="form-group">
+ <label for="domain_name" class="col-sm-3 control-label">Domain</label>
+
+ <div class="col-sm-6">
+ <select required id="domain_name" class="js-example-basic form-control" name="domain_name">
+ </select>
+ </div>
+ </div>
</div>