<form>
<div class="ui-form-item ui-border-b">
<label>预留手机号：</label>
<span id="MOBILE_NO"></span>
</div>
<div class="ui-form-item ui-border-b">
<label>动态验证码：</label>
<input id="securityCode" type="text" placeholder="请输入验证码" data-type="zipcode" readonly="readonly" data-len="6"
maxlength="4" style="width: 20%;"/>
<button class="ui-btn ui-btn-primary" style="margin-top: 7px;background-color: orange;">点击发送</button>
</div>
<div class="ui-form-item ui-border-b">
<label >预约余额：</label>
<input type="text" id="ORDER_AMT" placeholder="请输入预约金额" maxlength="10"
pattern="\d*" readonly="readonly" />
</div>
<div class="ui-form-item ui-border-b">
<label >预约日期：</label>
<span id="ORDER_DATE"></span>
</div>
</form>
<div class="ui-form-item ui-border-b">
<label>预留手机号：</label>
<span id="MOBILE_NO"></span>
</div>
<div class="ui-form-item ui-border-b">
<label>动态验证码：</label>
<input id="securityCode" type="text" placeholder="请输入验证码" data-type="zipcode" readonly="readonly" data-len="6"
maxlength="4" style="width: 20%;"/>
<button class="ui-btn ui-btn-primary" style="margin-top: 7px;background-color: orange;">点击发送</button>
</div>
<div class="ui-form-item ui-border-b">
<label >预约余额：</label>
<input type="text" id="ORDER_AMT" placeholder="请输入预约金额" maxlength="10"
pattern="\d*" readonly="readonly" />
</div>
<div class="ui-form-item ui-border-b">
<label >预约日期：</label>
<span id="ORDER_DATE"></span>
</div>
</form>
