<form class="Submit_form fix"

action="{APP_PATH}index.php?m=formguide&c=index&a=show&formid=16&action=js&siteid=1"

method="post">

<div class="Submit_bl fix">

<span>姓名:</span><input type="text" class="Submit_text" name="info[name]"/>

</div>

<div class="Submit_bl fix">

<span>联系手机:</span><input type="text" class="Submit_text" name="info[tel]"/>

</div>

<div class="Submit_bl fix">

<span>联系地址:</span><input type="text" class="Submit_text" name="info[address]"/>

</div>

<div class="Submit_bl fix">

<span>检测类别:</span>

<select class="Submit_select" name="info[jclb]">

{pc:content action="category" catid="12" order="listorder ASC"}

{loop $data $r}

<option value="{$r[catname]}">{$r[catname]}</option>

{/loop}

{/pc}

</select>

</div>

<div class="Submit_bl fix">

<span>检测点数:</span><input type="text" class="Submit_text" name="info[jcds]"/>

</div>

<div class="Submit_bl fix">

<span>预约时间:</span><input type="text" class="Submit_text" name="info[yysj]" id="test1"/>

</div>



<script src="/statics/laydate/laydate.js"></script> <!-- 改成你的路径 -->

<script>

//执行一个laydate实例

laydate.render({

elem: '#test1' //指定元素

});

</script>



{php pc_base::load_sys_class('form', '', 0)}

<div class="Submit_bl fix">

<span>输入验证码:</span><input type="text" class="Submit_text1" name="code"/>

<div class="Submit_code">{form::checkcode('code_img', '4', '14', 100, 30)}</div>

</div>

<div class="Submit_bl1 fix">

<span>备注:</span>

<textarea class="Submit_textarea" name="info[beizhu]"></textarea>

</div>

<div class="Submit_tj fix">

<input type="submit" class="Submit_submit" value="提交" name="dosubmit"/>

</div>

</form>