<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 id="pg_title" data-lang="account_delete_title" class="title">Delete Account</div>
      <div class="title-large">
        <div id="pg_title_large" data-lang="account_delete_title" 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>