<form>
    <div class="row">
        <div class="large-8 small-centered columns">
            <fieldset>
                <legend>Shipping address</legend>
                <div class="row">
                    <div class="small-12 columns">
                      <input type="text" id="first_name" placeholder="First name"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-12 columns">
                      <input type="text" id="last_name" placeholder="Last name"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-12 columns">
                      <input type="text" id="address_1" placeholder="Address 1"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-12 columns">
                      <input type="text" id="address_2" placeholder="Address 2"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-12 columns">
                      <input type="text" id="town_city" placeholder="Town/city"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-8 columns">
                      <input type="text" id="state_province" placeholder="State/province"></input>
                    </div>
                    <div class="small-4 columns">
                      <input type="text" id="postcode_zip" placeholder="Postcode/zip"></input>
                    </div>
                </div>    
                <div class="row">
                    <div class="small-12 columns">
                      <input type="tel" id="phone" placeholder="Phone"></input>
                    </div>
                </div>    
            </fieldset>
        </div>
    </div>
</form>