<td class="labelField">No Telp</td>
<td><input type="text" name="noTelepon" id="noTelepon" value="" class="noTelepon" data-rule-number required /></td>
</tr>
<tr>
<td class="labelField">No Identitas</td>
<td><input type="text" name="noIdentitas" id="noIdentitas" class="noIdentitas" value="" required/></td>
</tr>
</table>
</div>
<div class="span6">
<table>
<tr>
<td class="labelField">Propinsi</td>
<td><?php
dropDownPropinsi('name="propinsi" id="propinsi" class="propinsi" ');
?>
</td>
</tr>
<tr>
<td class="labelField">Kabupaten</td>
<td>
<select name="kabupaten" id="kabupaten" class="kabupaten" ><option value="">...</option></select>
</td>
</tr>
<tr>
<td class="labelField">Kecamatan</td>
<td>
<select name="kecamatan" id="kecamatan" class="kecamatan" ><option value="">...</option></select>
</td>
</tr>
<td class="labelField">No Telp</td>
<td><input type="text" name="noTelepon" id="noTelepon" value="" class="noTelepon" data-rule-number required /></td>
</tr>
<tr>
<td class="labelField">No Identitas</td>
<td><input type="text" name="noIdentitas" id="noIdentitas" class="noIdentitas" value="" required/></td>
</tr>
</table>
</div>
<div class="span6">
<table>
<tr>
<td class="labelField">Propinsi</td>
<td><?php
dropDownPropinsi('name="propinsi" id="propinsi" class="propinsi" required');
?>
</td>
</tr>
<tr>
<td class="labelField">Kabupaten</td>
<td>
<select name="kabupaten" id="kabupaten" class="kabupaten" required><option value="">...</option></select>
</td>
</tr>
<tr>
<td class="labelField">Kecamatan</td>
<td>
<select name="kecamatan" id="kecamatan" class="kecamatan" required><option value="">...</option></select>
</td>
</tr>
