<div class="page page-address_edit" data-name="address_edit">
  <div class="navbar navbar-large">
    <div class="navbar-bg">
    </div>
    <div class="navbar-inner">
      <div class="left">
        <a href="#" class="link back">
          <i class="icon f7-icons arrow-back">arrow_left</i>
        </a>
      </div>
      <div class="title">Address Edit</div>
      <div class="title-large">
        <div class="title-large-text">Address Edit</div>
      </div>
      <div class="right">
      </div>
    </div>
  </div>
  <div class="page-content">
    <form class="mt-40 mb-40">
      <input value="" type="hidden" id="a2_id">
      <label for="a2_label">Label</label>
      <input value="" type="text" id="a2_label" placeholder="Label">
      <label for="a2_name">Name</label>
      <input value="" type="text" id="a2_name" placeholder="Name">
      <label for="a2_phone">Phone</label>
      <input value="" type="text" id="a2_phone" placeholder="Phone">
      <label for="a2_address">Address</label>
      <input value="" type="text" id="a2_address" placeholder="Address">
      <div class="grid grid-cols-2 grid-gap grid-no-margin">
        <div>
          <label for="a2_rt">Rt</label>
          <input value="" type="text" id="a2_rt" placeholder="Rt">
        </div>
        <div>
          <label for="a2_rw">Rw</label>
          <input value="" type="text" id="a2_rw" placeholder="Rw">
        </div>
        <div>
          <label for="a2_no">No</label>
          <input value="" type="text" id="a2_no" placeholder="No">
        </div>
        <div>
          <label for="a2_postcode">Post Code</label>
          <input value="" type="text" id="a2_postcode" placeholder="Post Code">
        </div>
      </div>
      <label for="a2_kel">Kel</label>
      <input value="" type="text" id="a2_kel" placeholder="Kel">
      <label for="a2_kec">Kec</label>
      <input value="" type="text" id="a2_kec" placeholder="Kec">
      <label for="a2_city">City</label>
      <input value="" type="text" id="a2_city" placeholder="City">
      <label for="a2_gmap">Gmap</label>
      <input value="" type="text" id="a2_gmap" placeholder="Gmap">
      <label for="a2_remark">Remark</label>
      <input value="" type="text" id="a2_remark" placeholder="Remark">
      <a href="#" id="address_edit_button" class="btn btn-primary btn-block fw-700">Save</a>
    </form>
  </div>
</div>