2023年3月3日 20:51:59go评论77阅读模式

英文:

How Can I Make Form Under Box?

问题

你好，我想在框下面制作表单（新引荐），我该如何做呢？我想在框下面添加名字、姓氏、出生日期、电话、电子邮件、地址等部分，但我无法解决。任何帮助都会感激。我在代码片段中分享了我的代码。我想在旁边添加图标并写上“名字”，我想要名字下面有一条线。其他部分也是这样。

英文:

Hello I want to make form under the box (new referral) how can I do it? I wanna add first name last name date of birth, phone, email, addres sections under the box but i could not solve it out. Any help appreciated. I shared my codes on code snippet. I wanna add icon and write First name side by side and I want line under first name. Others are like that too

* {
  margin: 0;
  border: 0;
  box-sizing: border-box;
  background: #CDE7ED;
}

.heading1 {
  position: absolute;
  width: 449px;
  height: 80px;
  top: 56px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 500;
  font-size: 30px;
  line-height: 40px;
  /* or 133% */
  text-align: center;
  background: #FFFFFF;
  color: #0B2B5B;
}

#navbar {
  position: relative;
  height: 196px;
  top: 0px;
  display: flex;
  justify-content: center;
  background: #FFFFFF;
}

.iki {
  height: 32px;
  left: 539px;
  top: 230px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 500;
  font-size: 24px;
  line-height: 32px;
  text-align: center;
  color: #0B2B5B;
}

.uc {
  height: 32px;
  left: 435px;
  top: 270px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 32px;
  /* identical to box height, or 160% */
  text-align: center;
  color: #0B2B5B;
}

.box {
  position: absolute;
  width: 782px;
  height: 380px;
  left: 470px;
  top: 334px;
  background: #FFFFFF;
  box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
  border-radius: 4px;
}

.box-header {
  width: 782px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #FFFFFF;
  border-radius: 4px 4px 0px 0px;
  display: flex;
}

.b1 {
  width: 40px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #25A575;
  border-radius: 4px 0px 0px 0px;
}

.b11 {
  width: 10px;
  height: 32px;
  left: 264px;
  top: 350px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 500;
  font-size: 26px;
  line-height: 32px;
  display: flex;
  align-items: center;
  text-align: center;
  font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
  color: #FFFFFF;
  background: #25A575;
}

.new {
  position: sticky;
  width: 132px;
  height: 24px;
  left: 305px;
  top: 354px;
  padding-left: 10px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 24px;
  /* identical to box height, or 120% */
  display: flex;
  align-items: center;
  font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
  color: #3A719B;
  background-color: white;
}

.box-body {
  width: 295px;
  height: 16px;
  left: 24px;
  top: 0px;
  font-family: &#39;Montserrat&#39;;
  font-style: normal;
  font-weight: 400;
  font-size: 16px;
  line-height: 16px;
  /* identical to box height, or 100% */
  display: flex;
  align-items: center;
  color: #3A719B;
}

.line {
  position: absolute;
  left: 0%;
  right: 0%;
  top: 100%;
  bottom: 0%;
  border: 1px solid #3A719B;
}

&lt;header class=&quot;header&quot;&gt;
    &lt;div class=&quot;container&quot;&gt;
        &lt;nav id=&quot;navbar&quot;&gt;
            &lt;h1 class=&quot;heading1&quot;&gt;Patient Referral Form Hayes Valley Health San Francisco &lt;/h1&gt;

        &lt;/nav&gt;
    &lt;/div&gt;
&lt;/header&gt;
&lt;br&gt;
&lt;h2 class=&quot;iki&quot;&gt;Referral Patients&lt;/h2&gt;
&lt;h3 class=&quot;uc&quot;&gt;You can add up to five patients at a time&lt;/h3&gt;
&lt;div class=&quot;box&quot;&gt;
    &lt;div class=&quot;box-header&quot;&gt;
        &lt;div class=&quot;b1&quot;&gt;
            &lt;div class=&quot;b11&quot;&gt;
                1
            &lt;/div&gt;
        &lt;/div&gt;
        &lt;div class=&quot;new&quot;&gt;
            New Referral 
        &lt;/div&gt;
    &lt;/div&gt;
    &lt;br&gt; 
&lt;/div&gt;

答案1

得分: 0

你可以重命名标签：

<!-- begin snippet: js hide: false console: true babel: false -->

<!-- language: lang-css -->
* {
  margin: 0;
  border: 0;
  box-sizing: border-box;
  background: #CDE7ED;
}

.heading1 {
  position: absolute;
  width: 449px;
  height: 80px;
  top: 56px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 30px;
  line-height: 40px;
  /* or 133% */
  text-align: center;
  background: #FFFFFF;
  color: #0B2B5B;
}

#navbar {
  position: relative;
  height: 196px;
  top: 0px;
  display: flex;
  justify-content: center;
  background: #FFFFFF;
}

.iki {
  height: 32px;
  left: 539px;
  top: 230px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 24px;
  line-height: 32px;
  text-align: center;
  color: #0B2B5B;
}

.uc {
  height: 32px;
  left: 435px;
  top: 270px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 32px;
  /* identical to box height, or 160% */
  text-align: center;
  color: #0B2B5B;
}

.box {
  position: absolute;
  width: 782px;
  height: 380px;
  left: 470px;
  top: 334px;
  background: #FFFFFF;
  box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
  border-radius: 4px;
}

.box-header {
  width: 782px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #FFFFFF;
  border-radius: 4px 4px 0px 0px;
  display: flex;
}

.b1 {
  width: 40px;
  height: 64px;
  left: 249px;
  top: 334px;
  background: #25A575;
  border-radius: 4px 0px 0px 0px;
}

.b11 {
  width: 10px;
  height: 32px;
  left: 264px;
  top: 350px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 26px;
  line-height: 32px;
  display: flex;
  align-items: center;
  text-align: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #FFFFFF;
  background: #25A575;
}

.new {
  position: sticky;
  width: 132px;
  height: 24px;
  left: 305px;
  top: 354px;
  padding-left: 10px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 500;
  font-size: 20px;
  line-height: 24px;
  /* identical to box height, or 120% */
  display: flex;
  align-items: center;
  font-feature-settings: 'pnum' on, 'lnum' on;
  color: #3A719B;
  background-color: white;
}

.box-body {
  width: 295px;
  height: 16px;
  left: 24px;
  top: 0px;
  font-family: 'Montserrat';
  font-style: normal;
  font-weight: 400;
  font-size: 16px;
  line-height: 16px;
  /* identical to box height, or 100% */
  display: flex;
  align-items: center;
  color: #3A719B;
}

.line {
  position: absolute;
  left: 0%;
  right: 0%;
  top: 100%;
  bottom: 0%;
  border: 1px solid #3A719B;
}

#frm {
  display: flex;
  flex-direction: column;
}

<!-- language: lang-html -->
<header class="header">
    <div class="container">
        <nav id="navbar">
            <h1 class="heading1">Patient Referral Form Hayes Valley Health San Francisco </h1>
        </nav>
    </div>
</header>
<br>
<h2 class="iki">Referral Patients</h2>
<h3 class="uc">You can add up to five patients at a time</h3>
<div class="box">
    <div class="box-header">
        <div class="b1">
            <div class="b11">
                1
            </div>
        </div>
        <div class="new">
            New Referral
        </div>
        <form action="#" id="frm">
            <label for="name">Name</label>
            <input type="text" id="name">
            
            <label for="name2">Name</label>
            <input type="text" id="name2">
            
            <label for="name3">Name</label>
            <input type="text" id="name3">
            
            <label for="name">Name</label>
            <input type="text" id="name">
            
            <label for="name4">Name</label>
            <input type="text" id="name4">
            
            <label for="name5">Name</label>
            <input type="text" id="name5">
            <button type="submit">Send</button>
        </form>
    </div>
    <br>
</div>

<!-- end snippet -->

更多信息：https://www.w3schools.com/html/html_forms.asp

英文:

You can rename Labels:

* {
margin: 0;
border: 0;
box-sizing: border-box;
background: #CDE7ED;
}
.heading1 {
position: absolute;
width: 449px;
height: 80px;
top: 56px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 30px;
line-height: 40px;
/* or 133% */
text-align: center;
background: #FFFFFF;
color: #0B2B5B;
}
#navbar {
position: relative;
height: 196px;
top: 0px;
display: flex;
justify-content: center;
background: #FFFFFF;
}
.iki {
height: 32px;
left: 539px;
top: 230px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 24px;
line-height: 32px;
text-align: center;
color: #0B2B5B;
}
.uc {
height: 32px;
left: 435px;
top: 270px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 32px;
/* identical to box height, or 160% */
text-align: center;
color: #0B2B5B;
}
.box {
position: absolute;
width: 782px;
height: 380px;
left: 470px;
top: 334px;
background: #FFFFFF;
box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
border-radius: 4px;
}
.box-header {
width: 782px;
height: 64px;
left: 249px;
top: 334px;
background: #FFFFFF;
border-radius: 4px 4px 0px 0px;
display: flex;
}
.b1 {
width: 40px;
height: 64px;
left: 249px;
top: 334px;
background: #25A575;
border-radius: 4px 0px 0px 0px;
}
.b11 {
width: 10px;
height: 32px;
left: 264px;
top: 350px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 26px;
line-height: 32px;
display: flex;
align-items: center;
text-align: center;
font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
color: #FFFFFF;
background: #25A575;
}
.new {
position: sticky;
width: 132px;
height: 24px;
left: 305px;
top: 354px;
padding-left: 10px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 24px;
/* identical to box height, or 120% */
display: flex;
align-items: center;
font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
color: #3A719B;
background-color: white;
}
.box-body {
width: 295px;
height: 16px;
left: 24px;
top: 0px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 400;
font-size: 16px;
line-height: 16px;
/* identical to box height, or 100% */
display: flex;
align-items: center;
color: #3A719B;
}
.line {
position: absolute;
left: 0%;
right: 0%;
top: 100%;
bottom: 0%;
border: 1px solid #3A719B;
}
#frm{
display:flex;
flex-direction:column;
}

&lt;header class=&quot;header&quot;&gt;
&lt;div class=&quot;container&quot;&gt;
&lt;nav id=&quot;navbar&quot;&gt;
&lt;h1 class=&quot;heading1&quot;&gt;Patient Referral Form Hayes Valley Health San Francisco &lt;/h1&gt;
&lt;/nav&gt;
&lt;/div&gt;
&lt;/header&gt;
&lt;br&gt;
&lt;h2 class=&quot;iki&quot;&gt;Referral Patients&lt;/h2&gt;
&lt;h3 class=&quot;uc&quot;&gt;You can add up to five patients at a time&lt;/h3&gt;
&lt;div class=&quot;box&quot;&gt;
&lt;div class=&quot;box-header&quot;&gt;
&lt;div class=&quot;b1&quot;&gt;
&lt;div class=&quot;b11&quot;&gt;
1
&lt;/div&gt;
&lt;/div&gt;
&lt;div class=&quot;new&quot;&gt;
New Referral 
&lt;/div&gt;
&lt;form action=&quot;#&quot; id=&quot;frm&quot;&gt;
&lt;label for=&quot;name&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name&quot;&gt;
&lt;label for=&quot;name2&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name2&quot;&gt;
&lt;label for=&quot;name3&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name3&quot;&gt;
&lt;label for=&quot;name&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name&quot;&gt;
&lt;label for=&quot;name4&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name4&quot;&gt;
&lt;label for=&quot;name5&quot;&gt;Name&lt;/label&gt;
&lt;input type=&quot;text&quot; id=&quot;name5&quot;&gt;
&lt;button type=&quot;submit&quot;&gt;Send&lt;/button&gt;
&lt;/form&gt;
&lt;/div&gt;
&lt;br&gt; 
&lt;/div&gt;

For More Infos: https://www.w3schools.com/html/html_forms.asp

答案2

得分: 0

尝试以下解决方案。

* {
    margin: 0;
    border: 0;
    box-sizing: border-box;
    background: #CDE7ED;
}

.heading1 {
    position: absolute;
    width: 449px;
    height: 80px;
    top: 56px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 500;
    font-size: 30px;
    line-height: 40px;
    text-align: center;
    background: #FFFFFF;
    color: #0B2B5B;
}

#navbar {
    position: relative;
    height: 196px;
    top: 0px;
    display: flex;
    justify-content: center;
    background: #FFFFFF;
}

.iki {
    height: 32px;
    left: 539px;
    top: 230px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 500;
    font-size: 24px;
    line-height: 32px;
    text-align: center;
    color: #0B2B5B;
}

.uc {
    height: 32px;
    left: 435px;
    top: 270px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 500;
    font-size: 20px;
    line-height: 32px;
    text-align: center;
    color: #0B2B5B;
}

.box {
    position: absolute;
    width: 782px;
    height: 380px;
    left: 470px;
    top: 334px;
    background: #FFFFFF;
    box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
    border-radius: 4px;
}

.box-header {
    width: 782px;
    height: 64px;
    left: 249px;
    top: 334px;
    background: #FFFFFF;
    border-radius: 4px 4px 0px 0px;
    display: flex;
}

.b1 {
    width: 40px;
    height: 64px;
    left: 249px;
    top: 334px;
    background: #25A575;
    border-radius: 4px 0px 0px 0px;
}

.b11 {
    width: 10px;
    height: 32px;
    left: 264px;
    top: 350px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 500;
    font-size: 26px;
    line-height: 32px;
    display: flex;
    align-items: center;
    text-align: center;
    font-feature-settings: 'pnum' on, 'lnum' on;
    color: #FFFFFF;
    background: #25A575;
}

.new {
    position: sticky;
    width: 132px;
    height: 24px;
    left: 305px;
    top: 354px;
    padding-left: 10px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 500;
    font-size: 20px;
    line-height: 24px;
    display: flex;
    align-items: center;
    font-feature-settings: 'pnum' on, 'lnum' on;
    color: #3A719B;
    background-color: white;
}

.box-body {
    width: 295px;
    height: 16px;
    left: 24px;
    top: 0px;
    font-family: 'Montserrat';
    font-style: normal;
    font-weight: 400;
    font-size: 16px;
    line-height: 16px;
    display: flex;
    align-items: center;
    color: #3A719B;
}

.line {
    position: absolute;
    left: 0%;
    right: 0%;
    top: 100%;
    bottom: 0%;
    border: 1px solid #3A719B;
}

.refField {
    width: 100%;
    margin-bottom: 1em;
    border: 1px solid blue;
    border-radius: 5px;
    height: 2em;
}

form {
    padding: 15px;
    border: 1px solid red;
}

英文:

Try below solution.

*{
margin: 0;
border: 0;
box-sizing: border-box;
background: #CDE7ED;
}
.heading1{
position: absolute;
width: 449px;
height: 80px;
top: 56px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 30px;
line-height: 40px;
/* or 133% */
text-align: center;
background: #FFFFFF;
color: #0B2B5B;
}
#navbar{
position: relative;
height: 196px;
top: 0px;
display: flex;
justify-content: center;
background: #FFFFFF;
}
.iki{
height: 32px;
left: 539px;
top: 230px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 24px;
line-height: 32px;
text-align: center;
color: #0B2B5B;
}
.uc{
height: 32px;
left: 435px;
top: 270px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 32px;
/* identical to box height, or 160% */
text-align: center;
color: #0B2B5B;
}
.box{
position: absolute;
width: 782px;
height: 380px;
left: 470px;
top: 334px;
background: #FFFFFF;
box-shadow: 0px 2px 4px rgba(11, 43, 91, 0.1);
border-radius: 4px;
}
.box-header{
width: 782px;
height: 64px;
left: 249px;
top: 334px;
background: #FFFFFF;
border-radius: 4px 4px 0px 0px;
display: flex;
}
.b1{
width: 40px;
height: 64px;
left: 249px;
top: 334px;
background: #25A575;
border-radius: 4px 0px 0px 0px;
}
.b11{
width: 10px;
height: 32px;
left: 264px;
top: 350px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 26px;
line-height: 32px;
display: flex;
align-items: center;
text-align: center;
font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
color: #FFFFFF;
background: #25A575;
}
.new{
position: sticky;  
width: 132px;
height: 24px;
left: 305px;
top: 354px;
padding-left: 10px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 500;
font-size: 20px;
line-height: 24px;
/* identical to box height, or 120% */
display: flex;
align-items: center;
font-feature-settings: &#39;pnum&#39; on, &#39;lnum&#39; on;
color: #3A719B;
background-color: white;
}
.box-body{
width: 295px;
height: 16px;
left: 24px;
top: 0px;
font-family: &#39;Montserrat&#39;;
font-style: normal;
font-weight: 400;
font-size: 16px;
line-height: 16px;
/* identical to box height, or 100% */
display: flex;
align-items: center;
color: #3A719B;
}
.line{
position: absolute;
left: 0%;
right: 0%;
top: 100%;
bottom: 0%;
border: 1px solid #3A719B;
}
.refField {
width: 100%;
margin-bottom: 1em;
border: 1px solid blue;
border-radius: 5px;
height: 2em;
}
form {
padding: 15px;
border: 1px solid red;
}

    &lt;!DOCTYPE html&gt;
&lt;html lang=&quot;en&quot;&gt;
&lt;head&gt;
&lt;meta charset=&quot;UTF-8&quot;&gt;
&lt;meta http-equiv=&quot;X-UA-Compatible&quot; content=&quot;IE=edge&quot;&gt;
&lt;meta name=&quot;viewport&quot; content=&quot;width=device-width, initial-scale=1.0&quot;&gt;
&lt;link rel=&quot;stylesheet&quot; href=&quot;style.css&quot;&gt;
&lt;script src=&quot;https://code.jquery.com/jquery-3.3.1.min.js&quot;&gt;&lt;/script&gt;
&lt;script src=&quot;https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.3/umd/popper.min.js&quot;&gt;&lt;/script&gt;
&lt;link rel=&quot;stylesheet&quot; href=&quot;https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.2.0/css/all.min.css&quot;&gt;
&lt;link rel=&quot;preconnect&quot; href=&quot;https://fonts.googleapis.com&quot;&gt;
&lt;link rel=&quot;preconnect&quot; href=&quot;https://fonts.gstatic.com&quot; crossorigin&gt;
&lt;link
href=&quot;https://fonts.googleapis.com/css2?family=Open+Sans:wght@400;700;800&amp;family=Oswald:wght@200;300;400&amp;display=swap&quot;
rel=&quot;stylesheet&quot;&gt;
&lt;link rel=&quot;stylesheet&quot; href=&quot;https://kit.fontawesome.com/0b27183842.css&quot; crossorigin=&quot;anonymous&quot;&gt;
&lt;title&gt;Document&lt;/title&gt;
&lt;/head&gt;
&lt;body&gt;
&lt;script src=&quot;app.js&quot;&gt;&lt;/script&gt;
&lt;header class=&quot;header&quot;&gt;
&lt;div class=&quot;container&quot;&gt;
&lt;nav id=&quot;navbar&quot;&gt;
&lt;h1 class=&quot;heading1&quot;&gt;Patient Referral Form Hayes Valley Health San Francisco &lt;/h1&gt;
&lt;/nav&gt;
&lt;/div&gt;
&lt;/header&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;h2 class=&quot;iki&quot;&gt;Referral Patients&lt;/h2&gt;
&lt;h3 class=&quot;uc&quot;&gt;You can add up to five patients at a time&lt;/h3&gt;
&lt;div class=&quot;box&quot;&gt;
&lt;div class=&quot;box-header&quot;&gt;
&lt;div class=&quot;b1&quot;&gt;
&lt;div class=&quot;b11&quot;&gt;
1
&lt;/div&gt;
&lt;/div&gt;
&lt;div class=&quot;new&quot;&gt;
New Referral
&lt;/div&gt;
&lt;/div&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;form action=&quot;/action_page.php&quot; method=&quot;get&quot;&gt;
&lt;label for=&quot;name&quot;&gt;Enter Your Name&lt;/label&gt;
&lt;input type=&quot;text&quot; name=&quot;name&quot; id=&quot;name&quot; class=&quot;refField&quot;&gt;
&lt;label for=&quot;email&quot;&gt;Enter Your Email&lt;/label&gt;
&lt;input type=&quot;email&quot; name=&quot;email&quot; id=&quot;email&quot; class=&quot;refField&quot;&gt;
&lt;label for=&quot;address&quot;&gt;Enter Your Street Address&lt;/label&gt;
&lt;input type=&quot;text&quot; name=&quot;address&quot; id=&quot;address&quot; class=&quot;refField&quot;&gt;
&lt;label for=&quot;name&quot;&gt;Select Your Choice&lt;/label&gt;
&lt;select name=&quot;selectValue&quot; id=&quot;Values&quot; class=&quot;refField&quot;&gt;
&lt;option value=&quot;select&quot;&gt;Select&lt;/option&gt;
&lt;option&gt;Test-1&lt;/option&gt;
&lt;option&gt;Test-2&lt;/option&gt;
&lt;option&gt;Test-3&lt;/option&gt;
&lt;/select&gt;
&lt;label for=&quot;zip&quot;&gt;Zip&lt;/label&gt;
&lt;input type=&quot;text&quot; name=&quot;zip&quot; id=&quot;zip&quot; class=&quot;refField&quot;&gt;
&lt;label for=&quot;state&quot;&gt;State&lt;/label&gt;
&lt;input type=&quot;text&quot; name=&quot;state&quot; id=&quot;state&quot; class=&quot;refField&quot;&gt;
&lt;/form&gt;
&lt;/div&gt;
&lt;/body&gt;
&lt;/html&gt;

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