inputdata.html

<div data-page="inputdata" class="page">
    <div class="navbar">
        <div class="navbar-inner">
            <div class="left"><a href="#" class="link back icon-only"><i class="icon icon-back"></i></a></div>
            <div class="center"><a href="#" class="link">Input Data</a></div>
        </div>
    </div>
<div class="page-content">
    <div class="spacer"></div>
<div class="content-block">
<div class="list-block">
  <ul>
    <li>
      <div class="item-content">
        <div class="item-inner">
          <div class="item-input">
              <input type="text" placeholder="Your Name" id="nama">
          </div>
        </div>
      </div>
    </li>
    <li>
      <div class="item-content">
        <div class="item-inner">
          <div class="item-input">
              <input type="text" placeholder="Phone" id="telp">
          </div>
        </div>
      </div>
    </li>
    <li>
      <div class="item-content">
        <div class="item-inner">
          <div class="item-input">
              <input type="text" placeholder="Address" id="alamat">
          </div>
        </div>
      </div>
    </li>
    <li>
      <div class="item-content">
        <div class="item-inner">
          <div class="item-input">
              <input type="button" value="Simpan" id="submit" class="button button-raised">
          </div>
        </div>
      </div>
    </li>
  </ul>
</div>
</div>