document.write("<script language=\"javascript\" type=\"text/javascript\" src=\"http://www.lanlyimc.com/statics/js/dialog.js\"></script><link href=\"http://www.lanlyimc.com/statics/css/table_form.css\" rel=\"stylesheet\" type=\"text/css\" /><link href=\"http://www.lanlyimc.com/statics/css/dialog.css\" rel=\"stylesheet\" type=\"text/css\" /><script type=\"text/javascript\" src=\"http://www.lanlyimc.com/statics/js/dialog.js\"></script><form method=\"post\" action=\"http://www.lanlyimc.com/index.php?m=formguide&c=index&a=show&formid=12&siteid=1\" name=\"myform\" id=\"myform\">  <table class=\"table_form\" width=\"100%\" cellspacing=\"0\">    <tbody>                <tr>      <th width=\"80\"> <font color=\"red\">*</font> 姓名 </th>      <td><input type=\"text\" name=\"info[name]\" id=\"name\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> 身份证号码 </th>      <td><input type=\"text\" name=\"info[card]\" id=\"card\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> 联系电话 </th>      <td><input type=\"text\" name=\"info[phone]\" id=\"phone\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> 手机 </th>      <td><input type=\"text\" name=\"info[Mobile]\" id=\"Mobile\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> E-mail </th>      <td><input type=\"text\" name=\"info[email]\" id=\"email\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> 地址 </th>      <td><input type=\"text\" name=\"info[address]\" id=\"address\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> <font color=\"red\">*</font> 预约产品 </th>      <td><input type=\"text\" name=\"info[product]\" id=\"product\" size=\"50\" value=\"\"  class=\"input-text\"  >  </td>    </tr>            <tr>      <th width=\"80\"> 备注 </th>      <td><textarea name=\'info[note]\' id=\'note\' style=\'width:90%;height:80px;\'   ></textarea>  </td>    </tr>        <tr>      <td></td>      <td><div class=\"submit ib\">          <input type=\"submit\" name=\"dosubmit\" id=\"dosubmit\" value=\" 提交 \">        </div>        </td>    </tr>      </tbody>      </table></form>");