document.writeln("<ul class=\'tc_baojia_ul\'>");
document.writeln("<form name=\'baojia_form\' id=\'baojia_form\' method=\'post\' action=\'#\' onsubmit=\"return baojia_addcheack('06');\">");

document.writeln("    <li class=\'l_quyu\'><label>区域</label>");
document.writeln("        <p>");
document.writeln("        <select name=\'bj_quyu06\' id=\'bj_quyu06\' class=\'bj_input_quyu\'>");
document.writeln("        <option value=\'\' selected=\'selected\'>请选择您所在的区域</option>");
document.writeln("<optgroup label='连云港'>");document.writeln("<option value=\'1|2|9|1,2,9\'>新浦区</option>");document.writeln("<option value=\'1|2|3|1,2,3\'>海州区</option>");document.writeln("<option value=\'1|2|8|1,2,8\'>连云区</option>");document.writeln("<option value=\'1|2|7|1,2,7\'>赣榆区</option>");document.writeln("<option value=\'1|2|6|1,2,6\'>东海县</option>");document.writeln("<option value=\'1|2|4|1,2,4\'>灌南县</option>");document.writeln("<option value=\'1|2|5|1,2,5\'>灌云县</option>");document.writeln("</optgroup>");
document.writeln("        </select>");
document.writeln("        </p>");
document.writeln("    </li>");
document.writeln("    <li class=\'l_chenghu\'><label>您的称呼</label><p><input name=\'bj_chenghu06\' id=\'bj_chenghu06\' type=\'text\' class=\'bj_input_name\' maxlength=\'10\' value=\'\' placeholder=\'请输入您的称呼\'></p></li>");
document.writeln("    <li class=\'l_dianhua\'><label>手机号码</label><p><input name=\'bj_dianhua06\' id=\'bj_dianhua06\' type=\'text\' class=\'bj_input_dianhua\' maxlength=\'13\' value=\'\' placeholder=\'请输入您的电话\'></p></li>");

document.writeln("<input name=\'bj_mianji_open06\' id=\'bj_mianji_open06\' type=\'hidden\' value=\'\'>");

	document.writeln("    <li class=\'l_mianji\'><label>房屋面积</label><p><input name=\'bj_mianji06\' id=\'bj_mianji06\' type=\'text\' class=\'bj_input_mianji\' maxlength=\'15\' value=\'\' placeholder=\'请输入您的房屋面积\' onKeyPress=\'if(event.keyCode<45||event.keyCode>57){event.returnValue=false;}\'></p></li>");


document.writeln("<input name=\'bj_beizhu_open06\' id=\'bj_beizhu_open06\' type=\'hidden\' value=\'1\'>");

	document.writeln("<input name=\'bj_beizhu06\' id=\'bj_beizhu06\' type=\'hidden\' value=\'\'>");

document.writeln("    <li class=\'l_sub\'><input name=\'\' type=\'submit\' class=\'bj_input_submit\' value=\'立即申请\' onclick=\"return baojia_addcheack('06');\" /></li>");

	document.writeln("    <li class=\'l_tips\'>我们承诺：该项服务免费，绝不产生任何费用，为了您的利益以及我们的口碑，您的隐私将被严格保密。</li>");

document.writeln("<textarea name=\'bj_formurl06\' id=\'bj_formurl06\' style=\'display:none\' rows=\'3\'></textarea>");
document.writeln("<input name=\'bj_leixing06\' id=\'bj_leixing06\' type=\'hidden\' value=\'2\'>");
document.writeln("</form>");
document.writeln("</ul>");
document.writeln("<div class=\'clear1\'></div>");
var str = window.document.location.href;
document.getElementById('bj_formurl06').value=str;