<form class="list">

        <input name="uuid_3" type="hidden">

        <input name="token_3" type="hidden">

        <ul>

          

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

            <div class="item-inner">

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

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

                <input name="email_3" type="text" disabled placeholder="Email">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input name="first_name_3" type="text" placeholder="First Name">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input name="last_name_3" type="text" placeholder="Last Name">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

              <div class="item-title item-label">Phone/WhatsApp</div>

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

                <input name="phone_3" type="text" placeholder="Phone/WhatsApp">

              </div>

            </div>

          </li>

          

        </ul>

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

          <div class="container">

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

          </div>





      </form>