First Name Middle Name Last Name Company Street Address </label> <label id="address-level2-container"> <span>City/Town</span> <input id="address-level2" type="text"/> </label> <label id="address-level1-container"> <span>State/Province</span> <input id="address-level1" type="text"/> </label> <label id="postal-code-container"> <span>Zip/Postal</span> <input id="postal-code" type="text"/> </label> <label id="country-container"> <span>Country</span> <select id="country"> <option/> <option value="US">United States</option> </select> </label> <label id="email-container"> <span>Email</span> <input id="email" type="email"/> </label> <label id="tel-container"> <span>Phone</span> <input id="tel" type="tel"/> </label> </form> <div id="controls-container"> <button id="cancel">Cancel</button> <button id="save" disabled="disabled">Save</button> </div> </body> </html>