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安徽省亳州市利辛縣城關(guān)鎮永興路北側、利張路南側揚天汽貿城三期0058幢（8#綜合樓）1501-1508

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<label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                姓名：
                    </label>
                    <div   id="yyemeiukk"   class="e_input p_FullName" data-ename="單行文本輸入框">
                        <input id="" name="item_22" data-type="1" data-subType="1"
                            class="InputText form-control" type="text"                             data-required="false"   maxlength="32"
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                        <div   id="yyemeiukk"   class="e_unit p_UnitName"></div>
                    </div>
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                                <div   id="yyemeiukk"   class="e_box form-group p_GenderBox" data-ename="單選信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                性別：
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                            <label class="option" for="23">
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                                男
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                            <label class="option" for="23">
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                                女
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                                            </div>
                </div>
                
                
                                                                
                                                
                                <div   id="yyemeiukk"   class="e_box form-group p_PhoneBox" data-ename="手機信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                手機：
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                    <div   id="yyemeiukk"   class="e_input p_phone" data-ename="手機輸入框">
                        <input id="" name="item_24" class="InputText form-control" maxlength="20" data-type="1"
                            data-subType="3" type="text"  data-required="false"  placeholder="請輸入手機號" tit="手機">
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                </div>
                
                
                                                                
                                                
                                <div   id="yyemeiukk"   class="e_box form-group p_TelephoneBox" data-ename="電話(huà)信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                電話(huà)：
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                    <div   id="yyemeiukk"   class="e_input p_telephone" data-ename="電話(huà)輸入框">
                        <input id="" name="item_25" class="InputText form-control" maxlength="32" data-type="1"
                            data-subType="4" type="text"  data-required="false"  placeholder="請輸入電話(huà)號碼" tit="電話(huà)">
                    </div>
                </div>
                
                
                                                                
                                                
                                <div   id="yyemeiukk"   class="e_box form-group p_TelephoneBox" data-ename="電話(huà)信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                傳真：
                    </label>
                    <div   id="yyemeiukk"   class="e_input p_telephone" data-ename="電話(huà)輸入框">
                        <input id="" name="item_26" class="InputText form-control" maxlength="32" data-type="1"
                            data-subType="4" type="text"  data-required="false"  placeholder="請輸入傳真號碼" tit="傳真">
                    </div>
                </div>
                
                
                                                                
                                                
                                <div   id="yyemeiukk"   class="e_box form-group p_EmailBox" data-ename="郵箱信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                郵箱：
                    </label>
                    <div   id="yyemeiukk"   class="e_input p_email" data-ename="郵箱輸入框">
                        <input id="" name="item_27" class="InputText form-control" maxlength="64" data-type="1"
                            data-subType="5" type="text"  data-required="false"  placeholder="請輸入郵箱" tit="郵箱">
                    </div>
                </div>
                
                
                                                                
                                                
                                <div data-foreachitem class="e_box form-group p_FullNameBox" data-ename="單行文本信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                地址：
                    </label>
                    <div   id="yyemeiukk"   class="e_input p_FullName" data-ename="單行文本輸入框">
                        <input id="" name="item_28" data-type="1" data-subType="1"
                            class="InputText form-control" type="text"                             data-required="false"   maxlength="255"  placeholder="請輸入地址" tit="地址" />
                        <div   id="yyemeiukk"   class="e_unit p_UnitName"></div>
                    </div>
                </div>
                
                
                                                                
                                                
                                <div data-foreachitem class="e_box form-group p_FullNameBox" data-ename="單行文本信息區">
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                郵編：
                    </label>
                    <div   id="yyemeiukk"   class="e_input p_FullName" data-ename="單行文本輸入框">
                        <input id="" name="item_29" data-type="1" data-subType="1"
                            class="InputText form-control" type="text"                             data-required="false"   maxlength="128"
                             placeholder="請輸入郵編" tit="郵編" />
                        <div   id="yyemeiukk"   class="e_unit p_UnitName"></div>
                    </div>
                </div>
                
                
                                                                                                
                <div   id="yyemeiukk"   class="e_box form-group p_CaptchasBox" data-ename="驗證碼">
                    
                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                        <span id="yyemeiukk"    class="e_title d_formItemStar color_error p_intentionIntroStar">*</span>
                        <span id="yyemeiukk"    class="i_captcha"> 驗證碼：</span>                    </label>
                    
                    
                    <div   id="yyemeiukk"   class="e_box p_EntryBox" data-ename="輸入驗證碼容器">
                        
                        <div   id="yyemeiukk"   class="e_input p_EntryInput" data-ename="驗證碼輸入框">
                            
                            <input name="captchas" class="InputText form-control" type="input" data-required="true" value=""
                                placeholder="請輸入驗證碼" maxlength="5" tit=" 驗證碼" data-error=" 驗證碼錯誤或已失效">
                        </div>
                        
                    </div>
                    
                    
                    <div   id="yyemeiukk"   class="e_image p_image" data-ename="驗證碼圖片">
                        <img src="" width="100%" height="100%" alt="驗證碼">
                    </div>
                    
                </div>
                
                
                <div   id="yyemeiukk"   class="e_wbox p_CoupWBox">
                    <button type="button" class="btn btn-primary submitPC p_submit" data-ename="提交按鈕">提交</button>
                </div>
                
                            </div>
            
        </form>
    </div>
    
        </div>
<script type="text/javascript">
    $comp({
        CorrectRequired: "請正確填寫(xiě)必填項數據！",
        DataFailed: "提交數據失??！",
        mp: " 不能為空",
        number: " 只能輸入數字",
        captchasErrorPrompt: "您輸入的驗證碼有誤，或已失效。",
        correct: " 請輸入正確的",
        correctG: " 請輸入正確格式的",
        hm: " 號碼",
        id: "portalResMessage_form-16397120043782220",
        lib: ["js/portalMessage/portalResMessage_form-01"],
        noDataFlag: "",
        success: "提交成功",
        submitRepeat: " 1分鐘內無(wú)法重復提交",
        submitError: " 暫時(shí)無(wú)法正常提交，請您稍后再試",
        submitUrl: "",
        submitTarget: "",
        selectId: "1"
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</div></div>       </div>  </div></div></div>       </div>  </div></div></div>       </div>  </div></div><div   class="yyemeiukk"   id="w_grid-1639711990246" class="w_grid-000"><div   id="yyemeiukk"   class="w_grid signal">   <div   id="yyemeiukk"   class="e_box e_box-000 p_gridbox">         <div   class="yyemeiukk"   id="content_box-1639711990246-0" class="e_box e_box-000 d_gridCell_0 p_gridCell"><div   class="yyemeiukk"   id="w_common_text-1639711990319" class="reset_style"><div><p style="text-align:center"><a ><span style="color:#FFFFFF"><span style="font-size:12px"><span style="font-family:微軟雅黑">Copyright 安徽榮康后勤管理服務(wù)有限公司 ? 2021-2024  All Rights Reserved    皖I(lǐng)CP備2021017533號-1</span></span></span></a></p>
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