<h4>{{ title }}</h4>

<p>
    <label for="name">Название точки
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        <input type="text" name="stock_name" required class="smallinput" >
    </span>
</p>
<p>
    <label for="name">Страна
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        {{countryField|raw}}
    </span>
</p>
<p>
    <label for="name">Область
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        {{regionField|raw}}
    </span>
</p>
<p>
    <label for="name">Город
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        {{cityField|raw}}
    </span>
</p>
<p>
    <label for="name">Улица
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        <input type="text" name="stock_street" class="smallinput" >
    </span>
    
</p>
<p>
    <label for="name">Дом
        <span class="required_sign">*</span>
    </label>
    <span class="field">
        <input type="text" name="stock_house"  class="smallinput" >
    </span>
    
</p>


<p>
    <label for="name">Квартира/Офис
    </label>
    <span class="field">
        <input type="text" name="stock_room" class="smallinput" >
    </span>
    
</p>
