<form class="list">

        <input type="hidden" id="ad_id">

        <ul>

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

            <div class="item-inner">

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

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

                <input id="ad_label" type="text" placeholder="Label">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input id="ad_name" type="text" placeholder="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 id="ad_phone" type="text" placeholder="Phone/WhatsApp">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <textarea id="ad_address" placeholder="Address"></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">RT</div>

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

                      <input id="ad_rt" type="text" placeholder="RT">

                    </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">RW</div>

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

                      <input id="ad_rw" type="text" placeholder="RW">

                    </div>

                  </div>

                </div>

              </div>

            </div>

          </li>

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

          <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">No</div>

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

                      <input id="ad_no" type="text" placeholder="No">

                    </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">Kode Pos</div>

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

                      <input id="ad_postcode" type="text" placeholder="Kode Pos">

                    </div>

                  </div>

                </div>

              </div>

            </div>

          </li>

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

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

            <div class="item-inner">

              <div class="item-title item-label">Desa/Kelurahan</div>

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

                <input id="ad_kel" type="text" placeholder="Desa/Kelurahan">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input id="ad_kec" type="text" placeholder="Kecamatan">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <input id="ad_city" type="text" placeholder="Kota">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

              <div class="item-title item-label">URL GoogleMap</div>

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

                <input id="ad_gmap" type="text" placeholder="URL GoogleMap">

              </div>

            </div>

          </li>

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

            <div class="item-inner">

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

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

                <textarea id="ad_remark" placeholder="Keterangan"></textarea>

              </div>

            </div>

          </li>

          

        </ul>

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

          <div class="container">

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

          </div>

      </form>

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