<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<meta content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0" name="viewport">
<meta name="format-detection" content="telephone=no" />
<meta name="format-detection" content="email=no" />
<title>填写邮寄地址</title>
</head>
<body>
<div class="concentBox">
<div class="form-group" style="margin-top: 0.3rem;">
收到你的地址后,我们会为你寄出奖品,地址一旦提交后不可修改,请认真填写。
</div>
<form role="form" class="form-signin" id="defaultForm">
<div class="form-group">
<label for="username">姓名<span>*</span></label>
<input class="form-control"type="text" name="username" id="name" placeholder=""/>
</div>
<div class="form-group">
<label for="mobile">手机号<span>*</span></label>
<input class="form-control"type="text" name="mobile" id="tel" placeholder="请输入11位有效手机号"/>
</div>
<!---->
<div class="form-group">
<label >地区<span>*</span></label>
<div class="col-sm-5" style="float: left;width: 100%;padding: 0;">
<div class="col-sm-2" style="padding-left: 0;">
<select class="form-control" name='province' id="province">
<option value="0">请选择</option>
</select>
</div>
<div class="col-sm-2" style="padding: 0;">
<select class="form-control" name="city" id="city">
<option value="0">请选择</option>
</select>
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