chromium/components/test/data/autofill/heuristics/input/095_landsend.html

<!-- This form has several hidden elements. These should not split up or affect the interpretation of the form. -->
<form name="foo" method="post">
  <input class="shipping-address-index" type="hidden" value="1234">
  <input id="main-shipping-move-from-index" class="move-items-from-index" type="hidden" value="1234">
  <input class="shipping-cap" type="hidden" value="">
  <div>
    <div class="elt">
      <input type="hidden" value="USA" class="shipping-country"/>
    </div>
    <p class="elt">
      <label for="main-shipping-first-name">First Name</label>
      <input type="text" id="main-shipping-first-name" name="fname" class="shipping-first-name" value="" maxlength="32"/>
    </p>
    <p class="elt">
      <label for="main-shipping-last-name">Last Name</label>
      <input type="text" id="main-shipping-last-name" name="lname" class="shipping-last-name" value="" maxlength="32"/>
    </p>
    <p class="blah" style="display:none;"></p>
    <p class="elt">
      <label for="main-shipping-address-1">Address</label>
      <input id="main-shipping-address-1" name="address" class="shipping-address-1" type="text" value="" maxlength="30"/>
    </p>
    <p class="elt">
      <label for="main-shipping-address-2">Line 2</label>
      <input id="main-shipping-address-2" name="address" class="shipping-address-2" type="text" maxlength="30" placeholder="*Optional" />
    </p>
    <p class="elt" style="display:none;">
      <!-- Presumably the third-line of address is only used for certain locales. -->
      <label for="main-shipping-address-3">Line 3</label>
      <input id="main-shipping-address-3" name="address" class="shipping-address-3" type="text" maxlength="17" placeholder="*Optional"/>
    </p>
    <p class="blah" style="display:none;"></p>
    <p class="elt">
      <label for="main-shipping-city">City</label>
      <input id="main-shipping-city" name="city" class="shipping-city" type="text" value="" maxlength="30" />
    </p>
    <p class="blah" style="display:none;"></p>
    <p class="elt">
      <label for="main-shipping-state">State</label>
      <select id="main-shipping-state" class="shipping-state"></select>
    </p>
    <p class="elt" style="display:none;">
      <!-- Presumably this is Canada-only and hidden in the US. -->
      <label for="main-shipping-province">Province</label>
      <select id="main-shipping-province" class="shipping-province"></select>
    </p>
    <p class="blah" style="display:none;"></p>
    <p class="elt">
      <label for="main-shipping-zip">Zip Code</label>
      <input id="main-shipping-zip" name="zip" class="shipping-zip" type="text" value="" maxlength="15"/>
    </p>
  </div>
</form>