            </div>
                        <div class="col-md-6 form-group">
                            <label>City</label>
                            <input class="form-control" type="text" placeholder="New York">
                        </div>
                        <div class="col-md-6 form-group">
                            <label>State</label>
                            <input class="form-control" type="text" placeholder="New York">
                        </div>
                        <div class