<%file=5%>

 
 
 <div class=\"inside-banner\">
  <div class=\"banner-title\">
     聯絡我們 / Contact
  </div>
</div>


<div class=\"warpper\">
  <div class=\"main clearfix\"><!-- 編輯區 -->
  <!-- InstanceBeginEditable name=\"EditRegion1\" -->
 
    <div class=\"content-body\">
     <div class=\"col-025 col-m\">
     <div class=\"contact-left\"><img src=\"images/contactleft.jpg\"></div>
     </div>
     
     
     <div class=\"cor-075 col-m\"><!-- 左欄 -->
       <h3 class=\"page-title\">聯絡我們</h3>
       <div class=\"contact-body\">
       <form action=\"_form_mail.php?type=contant\" method=\"post\">
       <div class=\"contact-note\">* 為必填項目</div>
       <div class=\"form-box clearfix\"><!-- 表單 -->
       <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">聯絡人</span>
        <input type=\"text\" name=\"name\" placeholder=\"* 聯絡人\" class=\"input-main-style02\" alt=\"聯絡人\">
        </div>
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">公司名稱</span>
        <input type=\"text\" name=\"company\" placeholder=\"公司名稱\" class=\"input-main-style02\">
        </div>
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">統一編號</span>
        <input type=\"text\" name=\"company_no\" placeholder=\"統一編號\" class=\"input-main-style02\">
        </div>
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">聯絡電話</span>
        <input type=\"text\" name=\"phone\" placeholder=\"聯絡電話\" class=\"input-main-style02\">
        </div>
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">地址</span>
        <input type=\"text\" name=\"address\" placeholder=\"地址\" class=\"input-main-style02\">
        </div>
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">行動電話</span>
        <input type=\"text\" name=\"cellphone\" placeholder=\"* 行動電話\" class=\"input-main-style02\" alt=\"行動電話\">
        </div>
        
        <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">電子郵件</span>
        <input type=\"text\" name=\"email\" placeholder=\"* 電子郵件\" class=\"input-main-style02\" alt=\"電子郵件\">
        </div>
       <textarea rows=\"5\" class=\"input-style01\" type=\"text\" placeholder=\"意見欄\"></textarea>
       <div class=\"opinion clearfix\"> <span class=\"opinion-left01\">驗證碼</span>
       <input type=\"text\" name=\"code\" placeholder=\"請輸入驗證碼\" class=\"input-main-style02\" style=\" width:20%;\" alt=\"驗證碼\">
       <img src=\"verifycode.php\" width=\"auto\" height=\"31\" style=\"margin-left:10px;\" class=\"code\"/></div>
   		</form>
       <div class=\"cart-btn\"><a href=\"javascript:window.history.back(-1);\" class=\"btn-send\">回上一頁</a> <a href=\"javascript:checkform();\" class=\"btn-reset\">確認結帳</a></div>
       </div>
  </div>

     </div><!-- 左欄 EDN -->
     
     
    </div>
  <!-- InstanceEndEditable -->
  </div><!-- 編輯區 END -->
  </div>

 
 <%file=21%>

<%file=6%>