<form class="mt-40 mb-20">
  <label for="a1_action_at">Action At</label>
  <input type="datetime-local" id="a1_action_at" placeholder="Action At" value="">
  <label for="a1_bank">Bank</label>
  <input type="text" id="a1_bank" placeholder="Bank" value="">
  <label for="a1_amount">Amount</label>
  <input type="text" id="a1_amount" placeholder="Amount" value="">
  <label for="a1_descr">Description</label>
  <input type="text" id="a1_descr" placeholder="Description" value="">
  <label for="a1_invoice">Invoice</label>
  <input type="text" id="a1_invoice" placeholder="Invoice" value="">
  <label for="a1_pay_to">Pay To</label>
  <input type="text" id="a1_pay_to" placeholder="Pay To" value="">
  <label for="a1_pay_from">Pay From</label>
  <input type="text" id="a1_pay_from" placeholder="Pay From" value="">
  <label for="a1_reff_trx_id">Reff Trx Id</label>
  <input type="text" id="a1_reff_trx_id" placeholder="Reff Trx Id" value="">
  <label for="a1_reff_sales_id">Reff Sales Id</label>
  <input type="text" id="a1_reff_sales_id" placeholder="Reff Sales Id" value="">
  <a href="#" id="action_add_button" class="btn btn-primary btn-block fw-700 mb-30">Save</a>
</form>