<form class="list">

  <ul>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Bank Name</div>

        <div class="item-input-wrap">

          <input id="b3_bank_name" type="text" value="" placeholder="Bank Name">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Account Number</div>

        <div class="item-input-wrap">

          <input id="b3_account_number" type="text" value="" placeholder="Account Number">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Account Name</div>

        <div class="item-input-wrap">

          <input id="b3_account_name" type="text" value="" placeholder="Account Name">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">CIF</div>

        <div class="item-input-wrap">

          <input id="b3_cif" type="text" value=""  placeholder="CIF">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Swift Code</div>

        <div class="item-input-wrap">

          <input id="b3_swift_code" type="text" value=""  placeholder="Swift Code">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Currency</div>

        <div class="item-input-wrap">

          <input id="b3_currency" value="" type="text" placeholder="Currency">

        </div>

      </div>

    </li>

    <li class="item-content item-input">

      <div class="item-inner">

        <div class="item-title item-label">Balance</div>

        <div class="item-input-wrap">

          <input id="b3_balance" value="" type="text" placeholder="Balance">

        </div>

      </div>

    </li>

  </ul>

  <div class="separator-medium"></div>

  <div class="container">

    <button id="bank_add_button" class="btn btn-primary fw-700 btn-block">Save</button>

  </div>

</form>