            <div class="field">
                <label for="example5-phone" data-tid="elements_examples.form.phone_label">Phone</label>
                <input id="example5-phone" data-tid="elements_examples.form.phone_placeholder" class="input" type="text" placeholder="(941) 555-0123" required="" autocomplete="tel">
              </div>
            </div>
            <div data-locale-reversible>
              <div class="row">
                <div class="field">
                  <label for="example5-addres