<h3>Profile Autofill</h3>
<form name="addr1.1" id="form1" action="https://example.com" method="post">
Name: <input type="text" name="name"><br>
Line 1: <input type="text" name="addressLineOne"><br>
Line 2: <input type="text" name="addressLineTwo"><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>
<option value="QC">QC</option>
</select> <br>
Zip: <input name="zip" id="form_zip"> <br>
Email: <input name="email" id="form_email"> <br>
<input type="reset" value="Reset">
<input type="submit" value="Submit">
</form>