<div class="Polaris-FormLayout">
  <div class="Polaris-FormLayout__Item">    
    <div class="">
      <div class="Polaris-Labelled__LabelWrapper">
        <div class="Polaris-Label">
          <label class="Polaris-Label__Text">Store name</label>
        </div>
      </div>
      <div class="Polaris-Connected">
        <div class="Polaris-Connected__Item Polaris-Connected__Item--primary">
          <div data-paper-text-field-has-value-class="Polaris-TextField--hasValue" data-paper-text-field-clear-button-hidden-class="Polaris-TextField__Hidden" data-controller="paper-text-field" class="Polaris-TextField">
            <input type="text" id="" data-paper-text-field-target="input" data-action="paper-text-field#syncValue" class="Polaris-TextField__Input" />
            <div class="Polaris-TextField__Backdrop"></div>
          </div>
    </div>
      </div>
    </div>
  </div>
  <div class="Polaris-FormLayout__Item">    
    <div class="">
      <div class="Polaris-Labelled__LabelWrapper">
        <div class="Polaris-Label">
          <label class="Polaris-Label__Text">Account email</label>
        </div>
      </div>
      <div class="Polaris-Connected">
        <div class="Polaris-Connected__Item Polaris-Connected__Item--primary">
          <div data-paper-text-field-has-value-class="Polaris-TextField--hasValue" data-paper-text-field-clear-button-hidden-class="Polaris-TextField__Hidden" data-controller="paper-text-field" class="Polaris-TextField">
            <input type="text" id="" data-paper-text-field-target="input" data-action="paper-text-field#syncValue" class="Polaris-TextField__Input" />
            <div class="Polaris-TextField__Backdrop"></div>
          </div>
    </div>
      </div>
    </div>
  </div>
  <div class="Polaris-FormLayout__Item">    <button type="submit" data-controller="paper-button" class="Polaris-Button Polaris-Button--primary">
      <span class="Polaris-Button__Content">
        <div class="Polaris-Button__Text">
          Submit
        </div>
      </span>
    </button>
  </div>
</div>