d="ak-fieldbox-zip" class="required">
                  <input type="text" placeholder="Zip Code" name="zip" id="id_zip" class="ak-userfield-input" style="margin-right:8px" required>
                </div>
                <div id="ak-fieldbox-mobile_phone" class="required">
                  <input type="text" placeholder="Phone # (for text list)" name="phone" id="id_phone" class="ak-userfield-input">
                </div>
                <input type="hidden" name="country" value="United States">
         