TravelJoy

Shelley Moore

SeaShellz Travel

Bali Me Please

Bali

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="header" subtype="h2" label="Lead Passenger"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="radio-group" required="true" label="How many Travelers?" name="how-many-travelers">&#13;
			<option label="Solo" value="solo">Solo</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bedding Preference&amp;nbsp; (Request will be based on availability at check in)" name="bedding-preference-request-will-be-based-on-availability-at-check-in">&#13;
			<option label="Single " value="single-">Single </option>&#13;
			<option label="Double" value="double">Double</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Optional tours/add ons" name="optional-toursadd-ons">&#13;
			<option label="Uluwatu Temple Tour, Kecak Dance Show and Seafood dinner  $125 per person" value="uluwatu-temple-tour-kecak-dance-show-and-seafood-dinner-125-per-person">Uluwatu Temple Tour, Kecak Dance Show and Seafood dinner  $125 per person</option>&#13;
			<option label="Elephant Safari Tour $179  per person" value="elephant-safari-tour-179-per-person">Elephant Safari Tour $179  per person</option>&#13;
			<option label="Bali Instagram tour $112 per person" value="bali-instagram-tour-112-per-person">Bali Instagram tour $112 per person</option>&#13;
			<option label="Pre- nights in Ubad $150" value="pre-nights-in-ubad-150">Pre- nights in Ubad $150</option>&#13;
			<option label="Post -nights in Kuta $220" value="post-nights-in-kuta-220">Post -nights in Kuta $220</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you deposit ready?" name="are-you-ready-to-book">&#13;
			<option label="Ye, I'm ready to lock in this great rate." value="ye-im-ready-to-lock-in-this-great-rate">Ye, I'm ready to lock in this great rate.</option>&#13;
			<option label="No, I will come back when I'm ready." value="no-i-will-come-back-when-im-ready">No, I will come back when I'm ready.</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Travelers (Please add the First and Last name of each additional travelers)" name="additional-travelers-please-add-the-first-and-last-name-of-each-additional-travelers" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Ready to lock in your spot? How much should I authorize for deposit?&amp;nbsp; Deposit is $100 per person.&amp;nbsp;" inline="true" name="how-much-should-i-authorize-deposit-is-100-per-person-">&#13;
			<option label="Solo Traveler Authorize $100" value="solo-traveler-authorize-100">Solo Traveler Authorize $100</option>&#13;
			<option label="Two Travelers Authorize $200" value="two-travelers-authorize-200">Two Travelers Authorize $200</option>&#13;
			<option label="Three Travelers Authorize $300" value="three-travelers-authorize-300">Three Travelers Authorize $300</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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