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<title>加盟申请表</title>
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<td width="219"><img src="1/apply_1.gif"></td>
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<td ><p class="one">加盟申请表</p></td>
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<td width="18"><p class="second">注:打*为必填项</p></td>
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<td><p class="three"><strong>代理申请基本信息</strong></p> </td>
<td></td>
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<td><p class="four">申请人姓名<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<p class="four">籍贯<span class="fifth">*</span></p>
</td>
<td><select name="s">
<option value="0">请选择</option>
</select>省
<select name="q">
<option value="0">请选择</option>
</select>区
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<p class="four">性别<span class="fifth">*</span></p>
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<input name="gen"type="radio"class="input"value="n">男
<input name="gen"type="radio"class="input"value="s">女
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<td> <p class="four">身份证号<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<td> <p class="four">联系地址<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<td> <p class="four">电话<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<td> <p class="four">电子邮箱<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<td> <p class="four">加盟地区<span class="fifth">*</span></p></td>
<td><input name="xm"type="text"></td>
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<td rowspan="2"><p class="four">你是从哪里了解我们的?</p></td>
<td><input name="name1"type="checkbox"value=" ">Baidu
<input name="name2"type="checkbox"value=" ">Google
<input name="name3"type="checkbox"value="ds">电视广告
<input name="name4"type="checkbox"value="bk">报刊杂志
<input name="name5"type="checkbox"value="lp">路牌广告
<input name="name6"type="checkbox"value="py">朋友介绍
</td>
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<td><input name="name7"type="checkbox"value="pp">点击查看"Android"项目网上加盟免费声明<a href="#" targer="_blank">点击查看</a></td>
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加盟申请表
最新推荐文章于 2018-05-17 17:05:42 发布
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