<div class="form-group" [formGroup]="billingAddressForm">
  <label>Name On Card</label>
  <input type="text" class="form-control" formControlName="name">
  <label>Address</label>
  <input type="text" class="form-control" formControlName="address">
  <label>City</label>
  <input type="text" class="form-control" formControlName="city">
  <div class="row">
    <div class="col-md-6">
      <label>Province/State</label>
      <select class="form-control" formControlName="ProvinceState">
        <option>Ontario</option>
        <option>Michigan</option>
        <optgroup label="--- Canada ---">
          <option>Alberta</option>
          <option>British Columbia</option>
          <option>Manitoba</option>
          <option>Newfoundland</option>
          <option>New Brunswick</option>
          <option>Northwest Territories</option>
          <option>Nova Scotia</option>
          <option>Nunavut</option>
          <option>Prince Edward Island</option>
          <option>Quebec</option>
          <option>Saskatchewan</option>
          <option>Yukon</option>
        </optgroup>
        <optgroup label="--- United States ---">
          <option>Alabama</option>
          <option>Alaska</option>
          <option>Arizona</option>
          <option>Arkansas</option>
          <option>California</option>
          <option>Colorado</option>
          <option>Connecticut</option>
          <option>Delaware</option>
          <option>District of Columbia</option>
          <option>Florida</option>
          <option>Georgia</option>
          <option>Hawaii</option>
          <option>Idaho</option>
          <option>Illinois</option>
          <option>Indiana</option>
          <option>Iowa</option>
          <option>Kansas</option>
          <option>Kentucky</option>
          <option>Louisiana</option>
          <option>Maine</option>
          <option>Maryland</option>
          <option>Massachusetts</option>
          <option>Michigan</option>
          <option>Minnesota</option>
          <option>Mississippi</option>
          <option>Missouri</option>
          <option>Montana</option>
          <option>Nebraska</option>
          <option>Neveda</option>
          <option>New Hampshire</option>
          <option>New Jersey</option>
          <option>New Mexico</option>
          <option>New York</option>
          <option>North Carolina</option>
          <option>North Dakota</option>
          <option>Ohio</option>
          <option>Oklahoma</option>
          <option>Oregon</option>
          <option>Pennsylvania</option>
          <option>Rhode Island</option>
          <option>South Carolina</option>
          <option>South Dakota</option>
          <option>Tennessee</option>
          <option>Texas</option>
          <option>Utah</option>
          <option>Vermont</option>
          <option>Virgina</option>
          <option>Washington</option>
          <option>West Virginia</option>
          <option>Wisconsin</option>
          <option>Wyoming</option>
        </optgroup>
      </select></div>
    <div class="col-md-6">
      <label>Postal Code/Zip</label>
      <input type="text" class="form-control" formControlName="postal">
    </div>
  </div>
  <label>Telephone Number</label>
  <input type="text" class="form-control" formControlName="phoneNumber">
</div>