<div id='microinv-from-fields' style='margin-top:10px;'>
  <div name='fields' id='fields' style='margin-top:20px;'>
    <div style='float:left;height:40px;'></div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Name</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_name' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Url</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_url' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Description</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_description' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:100%;margin-top:20px;'>
      <label class="headlabel">Address (Postal Address)</label>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Street Address</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_street_address' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Address Locality(City)</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_address_locality' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Address Region(State)</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_address_region' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;margin-left:20px;width:150px;'>
      <label>Postal Code</label>
    </div>
    <div style='margin-left:70px;float:left;'>
      <input type='text' name='place_postal_code' class='text microinv-m-input input'/>
    </div>
    <div style='float:left;height:40px;'></div>
    <div style='float:left;height:40px;'></div>
  </div>
</div>
