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                                                姓名：
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                        <div   id="phtrn5l"   class="e_unit p_UnitName"></div>
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                                <div   id="j9ffdd5"   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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                    <div   id="ljj5vnl"   class="e_box d_CustomValueBox p_CustomValueBox">
                                                                        <div data-foreachitem class="e_radio p_sex">
                            <label class="option" for="23">
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                                男
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                        </div>
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                            <label class="option" for="23">
                                <input id="23" class="radio-inline" type="radio" name="item_23" value="2"
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                                女
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                        </div>
                                            </div>
                </div>
                
                
                                                                
                                                
                                <div   id="9nx9vnp"   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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                        <input id="" name="item_24" class="InputText form-control" maxlength="20" data-type="1"
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                    <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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                        <input id="" name="item_25" class="InputText form-control" maxlength="32" data-type="1"
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                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                傳真：
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                        <input id="" name="item_26" class="InputText form-control" maxlength="32" data-type="1"
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                    <label for="c_intentionIntro" class="e_title col-sm-2 control-label d_formItemTitle h5 color_normal p_intentionIntroTitle">
                                                郵箱：
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                        <input id="" name="item_27" class="InputText form-control" maxlength="64" data-type="1"
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                                <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：
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                    <div   id="b555xvn"   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="vlv9fdv"   class="e_unit p_UnitName"></div>
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                                <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：
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                    <div   id="5nzljpn"   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"
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                        <div   id="lb95t1p"   class="e_unit p_UnitName"></div>
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                <div   id="vldbzz5"   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="tjf955j"    class="e_title d_formItemStar color_error p_intentionIntroStar">*</span>
                        <span id="vnfbtnz"    class="i_captcha"> 驗證碼：</span>                    </label>
                    
                    
                    <div   id="bt9nfdb"   class="e_box p_EntryBox" data-ename="輸入驗證碼容器">
                        
                        <div   id="dvplfbn"   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="pfx9lxn"   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="l5zxvfb"   class="e_wbox p_CoupWBox">
                    <button type="button" class="btn btn-primary submitPC p_submit" data-ename="提交按鈕">提交</button>
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	                                        <span>津ICP備17001464號-2</span>
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