<div>
						<fieldset class="form-group">
						  <div class="input-group">
						  <span class="input-group-addon">订单编号</span>
							<input type="text" class="form-control" placeholder="<?php echo lang('subject');?>" name="pa" value="<?php echo $pa;?>" id="pa">
							</div>
						</fieldset>

						<fieldset class="form-group">
						  <div class="input-group">
						  <span class="input-group-addon">客户姓名</span>
							<input type="text" class="form-control" placeholder="<?php echo lang('subject');?>" name="pb" value="<?php echo $pb;?>" id="pb">
							</div>
						</fieldset>

						<fieldset class="form-group">
						  <div class="input-group">
						  <span class="input-group-addon">联系电话</span>
							<input type="text" class="form-control" placeholder="<?php echo lang('subject');?>" name="pc" value="<?php echo $pc;?>" id="pc">
							</div>
						</fieldset>

					</div>