TravelJoy

Tarun Richmond

Jireh Travel

Personalized Travel Planning

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="text" label="Full Name" name="full-name" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are you planning to travel in the next 3 - 6 months?&amp;nbsp;" name="are-you-planning-to-travel-in-the-next-3-6-months-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No " value="no-">No </option>&#13;
		</field>&#13;
		<field type="text" label="If you are planning to travel before 3 months, please tell us your ideal dates." name="if-you-are-planning-to-travel-before-3-months-please-tell-us-your-ideal-dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Do you have an idea of where you would like to go?" name="do-you-have-an-idea-of-where-you-would-like-to-go">&#13;
			<option label="I do!" value="i-do">I do!</option>&#13;
			<option label="I need some help figuring it out." value="i-need-some-help-figuring-it-out">I need some help figuring it out.</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, tell us about it below.&amp;nbsp;" name="if-yes-tell-us-about-it-below-" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="First Preference for Consultation Date&amp;nbsp;" name="ideal-consultation-date" className="form-control"/>&#13;
		<field type="date" label="Secondary Date Option!&amp;nbsp;" name="secondary-date-option-" className="form-control"/>&#13;
		<field type="select" label="What time works for you best?&amp;nbsp; (All times are in EST)" name="what-time-works-for-you-best-" className="form-control">&#13;
			<option label="6:30 pm " value="630-pm-">6:30 pm </option>&#13;
			<option label="7:00 pm " value="700-pm-">7:00 pm </option>&#13;
			<option label="7:30 pm " value="730-pm-">7:30 pm </option>&#13;
			<option label="5:30 pm " value="530-pm-">5:30 pm </option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>