<div class="field-group">
  <input type="hidden" name="id">
  <div class="field-wrapper">
    <label>Value</label>
    <input type="text" name="value" placeholder="$">
  </div>
  <div class="field-wrapper">
    <label>Date</label>
    <input type="date" name="date">
  </div>
  <button class="field-group-button">Submit</button>
</div>