<textarea class="form-control" name="{{name}}Street" rows="1" placeholder="{{translate 'Street'}}">{{streetValue}}</textarea>
<div class="row">
	<div class="col-sm-4">
		<input type="text" class="form-control" name="{{name}}City" value="{{cityValue}}" placeholder="{{translate 'City'}}">
	</div>
	<div class="col-sm-4">
		<input type="text" class="form-control" name="{{name}}State" value="{{stateValue}}" placeholder="{{translate 'State'}}">
	</div>
	<div class="col-sm-4">
		<input type="text" class="form-control" name="{{name}}PostalCode" value="{{postalCodeValue}}" placeholder="{{translate 'PostalCode'}}">
	</div>
</div>
<input type="text" class="form-control" name="{{name}}Country" value="{{countryValue}}" placeholder="{{translate 'Country'}}">

