       <input id="example5-city" data-tid="elements_examples.form.city_placeholder" class="input" type="text" placeholder="San Francisco" required="" autocomplete="address-level2">
                </div>
                <div class="field">
                  <label for="example5-state" data-tid="elements_examples.form.state_label">State</label>
                  <input id="example5-state" data-tid="elements_examples.form.state_placeholder" class="input empty" type="text" placeholder="CA" required="" autocomp