<form class="mt-40 mb-20">
  <input type="hidden" id="p1_product_id" value="">
  <label for="p1_action_at">Action At</label>
  <input type="datetime-local" id="p1_action_at" placeholder="Action At" value="">
  <label for="p1_qty">Qty</label>
  <input type="text" id="p1_qty" placeholder="Qty" value="">
  <label for="p1_due_days">Due Days</label>
  <input type="text" id="p1_due_days" placeholder="Due Days" value="">
  <label for="p1_pay_from">From</label>
  <input type="text" id="p1_pay_from" placeholder="From" value="">
  <label for="p1_invoice">Invoice</label>
  <input type="text" id="p1_invoice" placeholder="Invoice" value="">
  <label for="p1_remark">Remark</label>
  <input type="text" id="p1_remark" placeholder="Remark" value="">
  <a href="#" id="product_buy_button" class="btn btn-primary btn-block fw-700 mb-30">Save</a>
</form>