chromium/components/test/data/autofill/autofill_unowned_address_checkout.html

  Name: <input type="text" name="name" id="profile_autofill_name"><br>
  Address: <input type="text" name="address"><br>
  City: <input type="text" name="city"><br>
  State: <select name="state">
    <option value="CA">CA</option>
    <option value="MA">MA</option>
    <option value="NY">NY</option>
    <option value="MD">MD</option>
    <option value="OR">OR</option>
    <option value="OH">OH</option>
    <option value="IL">IL</option>
    <option value="DC">DC</option>
  </select> <br>
  Zip: <input name="zip" id="form_zip"> <br>
  Country: <input name="country" id="form_country"> <br>
  Email: <input name="email" id="form_email"> <br>
  Phone: <input name="phone" id="form_phone"> <br>
  <input type="reset" value="Reset">
  <input type="submit" value="Submit" id="profile_submit">