<div class="w1200 msg">
    <h3>选择赢未来<p>今天的加盟就是明天辉煌的起点</p></h3>
    <form method="post" id="contact-form" action="<?php echo admin_url('admin-ajax.php'); ?>">
    <ul>
        <li class="rename"><span><em>*</em> 联系人：</span><input id="rename" type="text" required name="comment_author" maxlength="30" placeholder="  请输入姓名  "></li>
        <li class="tel"><span><em>*</em> 联系电话：</span><input id="phone" type="number" required name="comment_author_phone" maxlength="11" placeholder="  请输入电话号码  "></li>
        <li class="addr">
            <span>加盟地区：</span>
            <input type="text" name="comment_provinces" maxlength="50" placeholder="  请输入省份  ">
            <input type="text" name="comment_city" maxlength="50" placeholder="  请输入城市 " style="margin: 0px 16px;">
            <input type="text" name="comment_area" maxlength="50" placeholder="  请输入区域 ">
        </li>
        <!-- <li class="company">
            <span>主营项目：</span>
            <input type="text" name="comment_compname" maxlength="300" placeholder="  请输入主营项目  ">
        </li> -->
        <li class="text"><span>备注留言：</span><textarea name="comment" maxlength="300" placeholder="请输入留言信息（最多300字符） "></textarea></li>
        <input type="hidden" name="action" value="submit_custom_comment">
        <input type="hidden" name="comment_post_ID" value="367" id="comment_post_ID"> 
        <input type="hidden" name="comment_author_IP" value="<? echo $_SERVER['REMOTE_ADDR']; ?>" id="comment_author_IP">
        <li class="btn"><button type="submit">马上提交</button></li>
    </ul>
    </form>
    </div>