<!DOCTYPE html>
<html lang="en" xmlns:th="http://www.thymeleaf.org">
<head>
    <script th:replace="common/head"></script>
    <!-- 省市区样式 -->
    <link rel="stylesheet" th:href="@{'/layui/lay/mymodules/region.css'}" media="all">
</head>
<body>
<div class="layui-fluid">
    <div class="layui-row layui-col-space15">
        <div class="layui-col-md12">
            <div class="layui-card">
                <div class="layui-card-body" pad15>
                    <div class="layui-form">
                        <div class="layui-form-item">
                            <label class="layui-form-label"><span class="must">*</span>名称</label>
                            <div class="layui-input-inline">
                                <input type="text" name="name" lay-verify="required"  placeholder="" autocomplete="off" class="layui-input">
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <label class="layui-form-label">
                                <span class="must">*</span>
                                <span>区域</span>
                            </label>
                            <div class="layui-input-inline" id="region_body">
                                <input type="hidden" lay-verify="required" name="regionProvince" />
                                <input type="hidden" lay-verify="required" name="regionCity" />
                                <input type="hidden" lay-verify="required" name="regionArea" />
                                <input type="text" name="region" lay-verify="required" autocomplete="off" class="layui-input" id="region" />
                                <div th:replace="common/region"></div>
                            </div>
                        </div>
                        <div class="layui-form-item layui-form-text">
                            <label class="layui-form-label">详细地址</label>
                            <div class="layui-input-block">
                                <textarea name="address" placeholder=""  class="layui-textarea w500"></textarea>
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <label class="layui-form-label"><span class="must">*</span>联系人</label>
                            <div class="layui-input-inline">
                                <input type="text" lay-verify="required" name="personName"  placeholder="" autocomplete="off"
                                       class="layui-input">
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <label class="layui-form-label"><span class="must">*</span>电话</label>
                            <div class="layui-input-inline">
                                <input type="text" lay-verify="required" name="personTel"  placeholder="" autocomplete="off"
                                       class="layui-input">
                            </div>
                        </div>
                        <div class="layui-form-item layui-form-text">
                            <label class="layui-form-label">备注</label>
                            <div class="layui-input-block">
                                <textarea name="remark" placeholder="请输入300字以内的备注介绍"  class="layui-textarea w500"></textarea>
                            </div>
                        </div>
                        <div class="layui-form-item">
                            <div class="layui-input-block">
                                <button class="layui-btn" lay-submit lay-filter="submit_button">提交</button>
                                <button type="reset" class="layui-btn layui-btn-primary" id="cancel_btn">取消</button>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<!-- javascript -->
<script th:src="@{'/layui/layui.js'}"></script>
<script>
    layui.config({
        base: '/' //静态资源所在路径
    });
</script>
<script th:src="@{'/js/implement/integrated-service-insert.js'}"></script>
</body>
</html>