<label>Address line 4 <em>(optional)</em><br><input name="address4" type="text" maxlength="32"></label><br>
<label>Safe place <em>(optional)</em><br><input name="safe_place" type="text" maxlength="32"></label><br>
<label>Delivery instructions <em>(optional)</em><br><input name="instructions" type="text" maxlength="32"></label><br>
<label>Address line 4 <em>(optional)</em><br><input name="address4" type="text" maxlength="32"></label><br>
<label>Safe place <em>(optional)</em><br><input name="safe_place" type="text" maxlength="32"></label><br>
<label>Delivery instructions <em>(optional)</em><br><input name="instructions" type="text" maxlength="32"></label><br>