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Cruise Request Form

Dec 31, 2028 to Dec 31, 2028

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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Paragraph"/>&#13;
		<field type="header" subtype="h2" label="Cruise Booking Request"/>&#13;
		<field type="header" subtype="h1" label="Thank you for choosing Lux Travel Express to tailor your next vacation! Please fill out each sections below so we can put together the best package to suit your budget and vacation!"/>&#13;
		<field type="header" subtype="h2" label="Client Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Cruise Preference&amp;nbsp;"/>&#13;
		<field type="text" label="Is this cruise for a specific occasion? (Birthday, Anniversary, Honeymoon, Wedding etc.)" name="is-this-cruise-for-a-specific-occasion-birthday-anniversary-honeymoon-wedding-etc" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What Is Your Departure City/Port? (Put more than one cruise port if you&#39;re open!)" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How Many Days Are You Wanting To Cruise:" name="how-many-days-are-you-wanting-to-cruise" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Please Select Your Cabin Type:" name="please-select-your-cabin-type" className="form-control">&#13;
			<option label="Interior (Inside Cabin;No Windows)" value="interior-inside-cabinno-windows">Interior (Inside Cabin;No Windows)</option>&#13;
			<option label="Ocean View (room with window to view *Ocean)" value="ocean-view-room-with-window-to-view-ocean">Ocean View (room with window to view *Ocean)</option>&#13;
			<option label="Balcony (Window with deck)" value="balcony-window-with-deck">Balcony (Window with deck)</option>&#13;
			<option label="Suite (Spacious and Luxurious)" value="suite-spacious-and-luxurious">Suite (Spacious and Luxurious)</option>&#13;
			<option label="Multiple Cabin Types " value="multiple-cabin-types-">Multiple Cabin Types </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Total Passangers&amp;nbsp;" name="total-passangers-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please list the first/last name of travelers along with birth dates." name="please-list-the-firstlast-name-of-travelers-along-with-birth-dates" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Will all guests be in the same cabin?" name="will-all-guests-be-in-the-same-cabin" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers Per Cabin?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Is This A Group? (8 or more people)" name="is-this-a-group-8-or-more-people">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="What Is Your Cruise Line Preference?" name="what-is-your-cruise-line-preference" multiple="multiple" className="form-control">&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Norwegian" value="norwegian">Norwegian</option>&#13;
			<option label="Celebrity " value="celebrity-">Celebrity </option>&#13;
			<option label="Princess Cruise " value="princess-cruise-">Princess Cruise </option>&#13;
			<option label="Not Listed" value="not-listed">Not Listed</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Have You Been On A Cruise Before?&amp;nbsp;" name="have-you-been-on-a-cruise-before-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Previous Cruise Line" name="previous-cruise-line" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Where would you like to sail to?" name="where-would-you-like-to-sail-to">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Bermuda " value="bermuda-">Bermuda </option>&#13;
			<option label="Easter Caribbean (British Virgin Islands, Puerto Rico, St. Martin, etc.)" value="easter-caribbean-british-virgin-islands-puerto-rico-st-martin-etc">Easter Caribbean (British Virgin Islands, Puerto Rico, St. Martin, etc.)</option>&#13;
			<option label="Western Caribbean (Cozumel, Costa Maya, Jamaica, Belize, Honduras)" value="western-caribbean-cozumel-costa-maya-jamaica-belize-honduras">Western Caribbean (Cozumel, Costa Maya, Jamaica, Belize, Honduras)</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="The Bahamas " value="the-bahamas-">The Bahamas </option>&#13;
			<option label="Not Listed " value="not-listed-">Not Listed </option>&#13;
		</field>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Travel Departure Date&amp;nbsp;" name="travel-departure-date-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are Your Dates Flexible ?" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Dining Time" name="dining-time">&#13;
			<option label="Early Dining 6pm" value="early-dining-6pm">Early Dining 6pm</option>&#13;
			<option label="Your Time Dining 5pm-9:30" value="your-time-dining-5pm930">Your Time Dining 5pm-9:30</option>&#13;
			<option label="Late Dining 8:15pm" value="late-dining-815pm">Late Dining 8:15pm</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget Per Traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$500 to 1000" value="500-to-1000">$500 to 1000</option>&#13;
			<option label="$1000 to $2,000" value="1000-to-2000">$1000 to $2,000</option>&#13;
			<option label="$2,500 to $4,000" value="2500-to-4000">$2,500 to $4,000</option>&#13;
			<option label="$5,000 to $8,500" value="5000-to-8500">$5,000 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are You Deposit Ready" name="are-you-deposit-ready">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will Anyone need Flights for this Vacation?" name="will-anyone-need-flights-for-this-vacation">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="&amp;nbsp;If you answered YES please list who will need flights and the city they will be flying in from:" name="-if-you-answered-yes-please-list-who-will-need-flights-and-the-city-they-will-be-flying-in-from" className="form-control"/>&#13;
		<field type="radio-group" label="Is anyone traveling over the age of 55?" name="is-anyone-traveling-over-the-age-of-55">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Is anyone traveling active or past military?" name="is-anyone-traveling-active-or-past-military">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Addisional Information&amp;nbsp;"/>&#13;
		<field type="radio-group" label="Would you need a Beverage Package?" name="would-you-need-a-beverage-package">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Which Beverage Package do you prefer? *Note: All beverage packages are prices per person. Alcoholic beverage packages must be purchased by each adult in the cabin." name="which-beverage-package-do-you-prefer-note-all-beverage-packages-are-prices-per-person-alcoholic-beverage-packages-must-be-purchased-by-each-adult-in-the-cabin">&#13;
			<option label="Alcoholic" value="alcoholic">Alcoholic</option>&#13;
			<option label="Non -Alcoholic" value="non-alcoholic">Non -Alcoholic</option>&#13;
			<option label="Both " value="both-">Both </option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you be interested in booking shore excursions?" name="would-you-be-interested-in-booking-shore-excursions">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="If YES, which shore excursions would you like to include?" name="if-yes-which-shore-excursions-would-you-like-to-include" className="form-control"/>&#13;
		<field type="text" label="List Name and Allergies, if any" name="list-name-and-allergies-if-any" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Insurance&amp;nbsp;"/>&#13;
		<field type="header" subtype="h1" label="I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred."/>&#13;
		<field type="radio-group" label="Do You Accept Travel Insurance?" name="do-you-accept-travel-insurance">&#13;
			<option label="Yes, I ACCEPT Travel Insurance." value="yes-i-accept-travel-insurance">Yes, I ACCEPT Travel Insurance.</option>&#13;
			<option label="No, I DECLINE Travel Insurance. I understand this could result in the loss of ALL of my travel costs." value="no-i-decline-travel-insurance-i-understand-this-could-result-in-the-loss-of-all-of-my-travel-costs">No, I DECLINE Travel Insurance. I understand this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Payment Info"/>&#13;
		<field type="header" subtype="h1" label="Payments and Deposits: Please be advised that payments plans are not available for departures that are within 60 days or less. Please be deposit ready as prices fluctuate and some holds last 24-72 hours depending on supplier. Are you Deposit Ready?"/>&#13;
		<field type="radio-group" label="Are You Deposit Ready&amp;nbsp;" name="are-you-deposit-ready-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Ready To Book" name="ready-to-book">&#13;
			<option label="ASAP with Deposit " value="asap-with-deposit-">ASAP with Deposit </option>&#13;
			<option label="Within the next 2 weeks " value="within-the-next-2-weeks-">Within the next 2 weeks </option>&#13;
			<option label="Within the next 8 weeks" value="within-the-next-8-weeks">Within the next 8 weeks</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will You Need A Payment Plan?" name="will-you-need-a-payment-plan">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="If YES, please select which payment plan option works best for you." name="if-yes-please-select-which-payment-plan-option-works-best-for-you">&#13;
			<option label="Monthly" value="monthly">Monthly</option>&#13;
			<option label="Bi-weekly (every other Friday)" value="biweekly-every-other-friday">Bi-weekly (every other Friday)</option>&#13;
			<option label="Weekly (every Friday)" value="weekly-every-friday">Weekly (every Friday)</option>&#13;
		</field>&#13;
		<field type="date" label="Date Field" name="date-1643359382007" className="form-control"/>&#13;
		<field type="textarea" label="How did you hear about Lux Travel Express" name="how-did-you-hear-about-lux-travel-express" className="form-control"/>&#13;
		<field type="radio-group" label="Are you interested in learning how you can save money and make money booking your own travel?" name="are-you-interested-in-learning-how-you-can-save-money-and-make-money-booking-your-own-travel">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Thank you for choosing Lux Travel Express"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

Terms & Conditions

We are Lux Travel Express and are excited to help you with your travel. The following terms & conditions (the "Agreement") describe what you can expect from us. The terms "we", "us", and "our" refer to Lux Travel Express and the term "you" refers to the individual who signs this agreement.

Click to sign

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="paragraph" subtype="p" label="Paragraph"/>&#13;
		<field type="header" subtype="h2" label="Cruise Booking Request"/>&#13;
		<field type="header" subtype="h1" label="Thank you for choosing Lux Travel Express to tailor your next vacation! Please fill out each sections below so we can put together the best package to suit your budget and vacation!"/>&#13;
		<field type="header" subtype="h2" label="Client Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Cruise Preference&amp;nbsp;"/>&#13;
		<field type="text" label="Is this cruise for a specific occasion? (Birthday, Anniversary, Honeymoon, Wedding etc.)" name="is-this-cruise-for-a-specific-occasion-birthday-anniversary-honeymoon-wedding-etc" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What Is Your Departure City/Port? (Put more than one cruise port if you&#39;re open!)" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How Many Days Are You Wanting To Cruise:" name="how-many-days-are-you-wanting-to-cruise" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Please Select Your Cabin Type:" name="please-select-your-cabin-type" className="form-control">&#13;
			<option label="Interior (Inside Cabin;No Windows)" value="interior-inside-cabinno-windows">Interior (Inside Cabin;No Windows)</option>&#13;
			<option label="Ocean View (room with window to view *Ocean)" value="ocean-view-room-with-window-to-view-ocean">Ocean View (room with window to view *Ocean)</option>&#13;
			<option label="Balcony (Window with deck)" value="balcony-window-with-deck">Balcony (Window with deck)</option>&#13;
			<option label="Suite (Spacious and Luxurious)" value="suite-spacious-and-luxurious">Suite (Spacious and Luxurious)</option>&#13;
			<option label="Multiple Cabin Types " value="multiple-cabin-types-">Multiple Cabin Types </option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Total Passangers&amp;nbsp;" name="total-passangers-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please list the first/last name of travelers along with birth dates." name="please-list-the-firstlast-name-of-travelers-along-with-birth-dates" subtype="text" className="form-control"/>&#13;
		<field type="select" label="Will all guests be in the same cabin?" name="will-all-guests-be-in-the-same-cabin" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers Per Cabin?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Is This A Group? (8 or more people)" name="is-this-a-group-8-or-more-people">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="What Is Your Cruise Line Preference?" name="what-is-your-cruise-line-preference" multiple="multiple" className="form-control">&#13;
			<option label="Carnival" value="carnival">Carnival</option>&#13;
			<option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Norwegian" value="norwegian">Norwegian</option>&#13;
			<option label="Celebrity " value="celebrity-">Celebrity </option>&#13;
			<option label="Princess Cruise " value="princess-cruise-">Princess Cruise </option>&#13;
			<option label="Not Listed" value="not-listed">Not Listed</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Have You Been On A Cruise Before?&amp;nbsp;" name="have-you-been-on-a-cruise-before-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Previous Cruise Line" name="previous-cruise-line" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Where would you like to sail to?" name="where-would-you-like-to-sail-to">&#13;
			<option label="Alaska" value="alaska">Alaska</option>&#13;
			<option label="Bermuda " value="bermuda-">Bermuda </option>&#13;
			<option label="Easter Caribbean (British Virgin Islands, Puerto Rico, St. Martin, etc.)" value="easter-caribbean-british-virgin-islands-puerto-rico-st-martin-etc">Easter Caribbean (British Virgin Islands, Puerto Rico, St. Martin, etc.)</option>&#13;
			<option label="Western Caribbean (Cozumel, Costa Maya, Jamaica, Belize, Honduras)" value="western-caribbean-cozumel-costa-maya-jamaica-belize-honduras">Western Caribbean (Cozumel, Costa Maya, Jamaica, Belize, Honduras)</option>&#13;
			<option label="Mexico" value="mexico">Mexico</option>&#13;
			<option label="The Bahamas " value="the-bahamas-">The Bahamas </option>&#13;
			<option label="Not Listed " value="not-listed-">Not Listed </option>&#13;
		</field>&#13;
		<field type="text" label="Where would you like to go?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Travel Departure Date&amp;nbsp;" name="travel-departure-date-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are Your Dates Flexible ?" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Dining Time" name="dining-time">&#13;
			<option label="Early Dining 6pm" value="early-dining-6pm">Early Dining 6pm</option>&#13;
			<option label="Your Time Dining 5pm-9:30" value="your-time-dining-5pm930">Your Time Dining 5pm-9:30</option>&#13;
			<option label="Late Dining 8:15pm" value="late-dining-815pm">Late Dining 8:15pm</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget Per Traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$500 to 1000" value="500-to-1000">$500 to 1000</option>&#13;
			<option label="$1000 to $2,000" value="1000-to-2000">$1000 to $2,000</option>&#13;
			<option label="$2,500 to $4,000" value="2500-to-4000">$2,500 to $4,000</option>&#13;
			<option label="$5,000 to $8,500" value="5000-to-8500">$5,000 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are You Deposit Ready" name="are-you-deposit-ready">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will Anyone need Flights for this Vacation?" name="will-anyone-need-flights-for-this-vacation">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="&amp;nbsp;If you answered YES please list who will need flights and the city they will be flying in from:" name="-if-you-answered-yes-please-list-who-will-need-flights-and-the-city-they-will-be-flying-in-from" className="form-control"/>&#13;
		<field type="radio-group" label="Is anyone traveling over the age of 55?" name="is-anyone-traveling-over-the-age-of-55">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Is anyone traveling active or past military?" name="is-anyone-traveling-active-or-past-military">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Addisional Information&amp;nbsp;"/>&#13;
		<field type="radio-group" label="Would you need a Beverage Package?" name="would-you-need-a-beverage-package">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Which Beverage Package do you prefer? *Note: All beverage packages are prices per person. Alcoholic beverage packages must be purchased by each adult in the cabin." name="which-beverage-package-do-you-prefer-note-all-beverage-packages-are-prices-per-person-alcoholic-beverage-packages-must-be-purchased-by-each-adult-in-the-cabin">&#13;
			<option label="Alcoholic" value="alcoholic">Alcoholic</option>&#13;
			<option label="Non -Alcoholic" value="non-alcoholic">Non -Alcoholic</option>&#13;
			<option label="Both " value="both-">Both </option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you be interested in booking shore excursions?" name="would-you-be-interested-in-booking-shore-excursions">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="If YES, which shore excursions would you like to include?" name="if-yes-which-shore-excursions-would-you-like-to-include" className="form-control"/>&#13;
		<field type="text" label="List Name and Allergies, if any" name="list-name-and-allergies-if-any" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Insurance&amp;nbsp;"/>&#13;
		<field type="header" subtype="h1" label="I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred."/>&#13;
		<field type="radio-group" label="Do You Accept Travel Insurance?" name="do-you-accept-travel-insurance">&#13;
			<option label="Yes, I ACCEPT Travel Insurance." value="yes-i-accept-travel-insurance">Yes, I ACCEPT Travel Insurance.</option>&#13;
			<option label="No, I DECLINE Travel Insurance. I understand this could result in the loss of ALL of my travel costs." value="no-i-decline-travel-insurance-i-understand-this-could-result-in-the-loss-of-all-of-my-travel-costs">No, I DECLINE Travel Insurance. I understand this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Payment Info"/>&#13;
		<field type="header" subtype="h1" label="Payments and Deposits: Please be advised that payments plans are not available for departures that are within 60 days or less. Please be deposit ready as prices fluctuate and some holds last 24-72 hours depending on supplier. Are you Deposit Ready?"/>&#13;
		<field type="radio-group" label="Are You Deposit Ready&amp;nbsp;" name="are-you-deposit-ready-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Ready To Book" name="ready-to-book">&#13;
			<option label="ASAP with Deposit " value="asap-with-deposit-">ASAP with Deposit </option>&#13;
			<option label="Within the next 2 weeks " value="within-the-next-2-weeks-">Within the next 2 weeks </option>&#13;
			<option label="Within the next 8 weeks" value="within-the-next-8-weeks">Within the next 8 weeks</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Will You Need A Payment Plan?" name="will-you-need-a-payment-plan">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="If YES, please select which payment plan option works best for you." name="if-yes-please-select-which-payment-plan-option-works-best-for-you">&#13;
			<option label="Monthly" value="monthly">Monthly</option>&#13;
			<option label="Bi-weekly (every other Friday)" value="biweekly-every-other-friday">Bi-weekly (every other Friday)</option>&#13;
			<option label="Weekly (every Friday)" value="weekly-every-friday">Weekly (every Friday)</option>&#13;
		</field>&#13;
		<field type="date" label="Date Field" name="date-1643359382007" className="form-control"/>&#13;
		<field type="textarea" label="How did you hear about Lux Travel Express" name="how-did-you-hear-about-lux-travel-express" className="form-control"/>&#13;
		<field type="radio-group" label="Are you interested in learning how you can save money and make money booking your own travel?" name="are-you-interested-in-learning-how-you-can-save-money-and-make-money-booking-your-own-travel">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Thank you for choosing Lux Travel Express"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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