<label class="control-label" for="<%= baseId %>"><%= label %></label>
<div class="controls">
    <button class="btn btn-primary btn-large" type="submit">
        <i class="icon-arrow-right icon-white"></i>
    </button>
    <input id="<%= baseId %>" type="text" name="<%= name %>" value="<%= value %>" class="" placeholder="<%= prompt %>" autocomplete="off" />
    <div data-loader-region></div>
</div>
