Domain:  		[	Textbox	]
				Page Name:	[	textbox	]
	
				(the boxes on the left are checkboxes)
	
				[ ]	Variable 1 [             ]    Value 1 [                   ]
				[ ]	Variable 2 [             ]    Value 2 [                   ]
	
				I say 7 of them unless you have a cool way to add another that's easy to do
	
				And then finally a Clear and Submit button.
	
				Submitting will post to the same page, and the values you picked would
				be at the top in text.  The fields will keep the values before (in
				case we want to submit again and again or submit and change one field)
				but in the HTML they would be this:
	
				<meta name="DCS.dcssip" content="(domain)" />
				<meta name="DCS.dcsuri" content="(page name)" />
				<meta name="DCSext.(variable1)" content="(value1)" />
				<meta name="DCSext.(variable2)" content="(value2)" />
			

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