<form class="mt-20">

  <label for="email">Email</label>

  <input type="text" id="email_4" name="email_4" placeholder="example@email.com">

  <label for="comment">Reason</label>

  <textarea id="reason_4" placeholder="Your comment here" id="comment"></textarea>



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

</form>