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<div id="autofill-edit-address-overlay" class="page" hidden>
<div class="close-button"></div>
<h1 id="autofill-address-title"></h1>
<div class="content-area">
<div id="autofill-name-labels">
<label for="first-name">
<span i18n-content="autofillFirstNameLabel"></span>
</label>
<label for="middle-name">
<span i18n-content="autofillMiddleNameLabel"></span>
</label>
<label for="last-name">
<span i18n-content="autofillLastNameLabel"></span>
</label>
</div>
<list id="full-name-list"></list>
<div class="input">
<label>
<div><span i18n-content="autofillCompanyNameLabel"></span></div>
<input id="company-name" type="text" class="autofill-form">
</label>
</div>
<div class="input">
<label>
<div><span i18n-content="autofillAddrLine1Label"></span></div>
<input id="addr-line-1" type="text" class="autofill-form">
</label>
</div>
<div class="input">
<label>
<div><span i18n-content="autofillAddrLine2Label"></span></div>
<input id="addr-line-2" type="text" class="autofill-form">
</label>
</div>
<div class="table">
<div class="row">
<div class="input cell">
<label for="city">
<span i18n-content="autofillCityLabel"></span>
</label>
</div>
<div class="input cell">
<label id="state-label" for="state"></label>
</div>
<div class="input cell">
<label id="postal-code-label" for="postal-code"></label>
</div>
</div>
<div class="row">
<div class="input cell">
<input id="city" type="text" class="autofill-form">
</div>
<div class="input cell">
<input id="state" type="text" class="autofill-form">
</div>
<div class="input cell">
<input id="postal-code" type="text" class="autofill-form">
</div>
</div>
</div>
<div class="input">
<label>
<div>
<span i18n-content="autofillCountryLabel"></span>
</div>
<select id="country"></select>
</label>
</div>
<div class="table">
<div class="row">
<div class="input cell">
<label for="phone-list">
<span i18n-content="autofillPhoneLabel"></span>
</label>
</div>
<div class="input cell">
<label for="email-list">
<span i18n-content="autofillEmailLabel"></span>
</label>
</div>
</div>
<div class="row">
<div class="input cell">
<list id="phone-list"
i18n-values="placeholder:autofillAddPhonePlaceholder"></list>
</div>
<div class="input cell">
<list id="email-list"
i18n-values="placeholder:autofillAddEmailPlaceholder"></list>
</div>
</div>
</div>
</div>
<div class="action-area button-strip">
<button id="autofill-edit-address-cancel-button" type="reset"
i18n-content="cancel"></button>
<button id="autofill-edit-address-apply-button" type="submit"
i18n-content="ok" disabled></button>
</div>
</div>
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