@layout("/common/_container.html"){
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<div class="ibox float-e-margins">
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<div class="ibox-content">
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<div class="form-horizontal" id="carInfoForm">
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<div class="row">
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<div class="col-sm-6">
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<div class="form-group">
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<label class="col-sm-3 control-label">*用户手机号: </label>
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<div class="col-sm-9">
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<input class="form-control" id="phone" name="name" autocomplete="off"
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placeholder="请输入用户手机号">
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-sm-6">
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<div class="form-group">
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<label class="col-sm-3 control-label">*赠送数量: </label>
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<div class="col-sm-9">
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<input class="form-control"
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id="number" name="name" autocomplete="off" placeholder="请输入赠送数量">
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</div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-sm-6">
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<div class="form-group">
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<label class="col-sm-3 control-label">备注: </label>
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<div class="col-sm-9">
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<textarea type="checkbox" id="remark" style="margin-left: 1%;width: 75%;height: 120px"
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placeholder="请输入备注"></textarea>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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<div class="row btn-group-m-t">
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<div class="col-sm-10 col-sm-offset-5">
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<#button btnCss="info" name="提交" id="ensure" icon="fa-check" clickFun="TSite.addSubmit()"/>
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<#button btnCss="danger" name="取消" id="cancel" icon="fa-eraser" clickFun="TSite.close()"/>
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</div>
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</div>
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</div>
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</div>
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</div>
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<script src="${ctxPath}/modular/system/tIntegral/tIntegral.js"></script>
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@}
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