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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="iskwmym"   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"
                             placeholder="請輸入姓名" tit="姓名" />
                        <div   id="aqcoe40"   class="e_unit p_UnitName"></div>
                    </div>
                </div>
                
                
                                                                
                                                
                                <div   id="4qemmoc"   class="e_box form-group p_GenderBox" data-ename="單選信息區">
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                                                性別：
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                    <div   id="iuk00is"   class="e_box d_CustomValueBox p_CustomValueBox">
                                                                        <div data-foreachitem class="e_radio p_sex">
                            <label class="option" for="23">
                                <input id="23" class="radio-inline" type="radio" name="item_23" value="1"
                                    checked="">
                                男
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                        </div>
                                                <div data-foreachitem class="e_radio p_sex">
                            <label class="option" for="23">
                                <input id="23" class="radio-inline" type="radio" name="item_23" value="2"
                                    checked="">
                                女
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                                <div   id="iyma0y0"   class="e_box form-group p_PhoneBox" data-ename="手機信息區">
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                                <div   id="kssw0iw"   class="e_box form-group p_TelephoneBox" data-ename="電話(huà)信息區">
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                                <div   id="oik0ksi"   class="e_box form-group p_EmailBox" data-ename="郵箱信息區">
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                    <div   id="0s0sc6k"   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>
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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">
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                    </label>
                    <div   id="cueseoe"   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="k00uaqu"   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：
                    </label>
                    <div   id="iseykwq"   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="qisesgs"   class="e_unit p_UnitName"></div>
                    </div>
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                <div   id="ug0myky"   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="4ukwmik"    class="e_title d_formItemStar color_error p_intentionIntroStar">*</span>
                        <span id="iysy0ym"    class="i_captcha"> 驗證碼：</span>                    </label>
                    
                    
                    <div   id="eqcoaoa"   class="e_box p_EntryBox" data-ename="輸入驗證碼容器">
                        
                        <div   id="ye0c6wg"   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="ks00ykw"   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="k0oo0se"   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>

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