<form class="list">

        <input id="a3_id" type="hidden" value="">

        <input id="a3_cat" type="hidden" value="">        

        <ul>

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

            <div class="item-inner">

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

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

                <input id="a3_action_at" type="date" placeholder="action_at">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input id="a3_to_from" type="text" placeholder="to_from">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input id="a3_invoice" type="text" placeholder="invoice">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <textarea id="a3_descr" placeholder="descr"></textarea>

              </div>

            </div>

          </li>

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

            <div class="row">

              <div class="col-50">

                <div class="item-content item-input item-input-with-value">

                  <div class="item-inner">

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

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

                      <input id="a3_qty" type="text" placeholder="qty">

                    </div>

                  </div>

                </div>

              </div>

              <div class="col-50">

                <div class="item-content item-input item-input-with-value">

                  <div class="item-inner">

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

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

                      <input id="a3_amount" type="text" placeholder="amount">

                    </div>

                  </div>

                </div>

              </div>

            </div>

          </li>

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

        </ul>

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

        <div class="container">

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

        </div>

      </form>

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