<div class="page page-account_delete" data-name="account_delete">

    <div class="navbar navbar-large">

      <div class="navbar-bg"></div>

      <div class="navbar-inner">

        <div class="left">

          <a href="#" class="link back">

            <i class="icon f7-icons arrow-back">arrow_left</i>

          </a>

        </div>

      <div class="title">Delete Account</div>

      <div class="title-large">

        <div class="title-large-text">Delete Account</div>

      </div>

        <div class="right">          

        </div>

      </div>

    </div>

    <div class="page-content">

    <form class="mt-40 mb-40">

  <input type="hidden" id="id" value="">

  <input type="hidden" id="no_telp" value="">

  <label data-lang="email" for="email">Email</label>

  <input type="text" id="email_4" name="email_4" value="" placeholder="example@email.com">

  <label data-lang="reason" for="comment">Reason</label>

  <textarea id="reason_4" data-ph_lang="comment" placeholder="Your comment here" id="comment">

  </textarea>

  <a href="#" data-lang="save" id="account_delete_button" class="button button-fill">Save</a>

</form>

  </div>

</div>