<div class="form-group">
  <label class="form-label">City</label>
  <input type="text" class="input" placeholder="City" />
</div>
<div class="form-group">
  <label class="form-label">State</label>
  <input type="text" class="input" placeholder="State" />
</div>
<div class="form-group">
  <label class="form-label">ZIP Code</label>
  <input type="text" class="input" placeholder="12345" />
</div>