TravelJoy

Megan Brebner

Palmhera Travel Group, Inc.

New Trip Request

<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><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Trip Details"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" description="If you're not sure  just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers? (Adults? Kids?)" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What services are you interested in us helping with?" name="what-services-are-you-interested-in">&#13;
			<option label="Accomodations" value="accomodations">Accomodations</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Ground Transportation" value="ground-transportation">Ground Transportation</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Activities/Tours" value="activitiestours">Activities/Tours</option>&#13;
			<option label="Consultation Only" value="consultation-only">Consultation Only</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for the above components for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true">&#13;
			<option label="Below $5,000" value="below-5000">Below $5,000</option>&#13;
			<option label="$5,000-$7,000" value="50007000">$5,000-$7,000</option>&#13;
			<option label="$7,000-$10,000" value="700010000">$7,000-$10,000</option>&#13;
			<option label="$10,000-$12,000" value="1000012000">$10,000-$12,000</option>&#13;
			<option label="$12,000+" value="12000">$12,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference">&#13;
			<option label="Economy (3 star or lower)" value="economy-3-star-or-lower">Economy (3 star or lower)</option>&#13;
			<option label="Moderate (4 star)" value="moderate-4-star">Moderate (4 star)</option>&#13;
			<option label="Luxury (5 star)" value="luxury-5-star">Luxury (5 star)</option>&#13;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What else would you like us to know? (Allergies, Restrictions, Things to Avoid, Celebrations, Bucket List items, etc) The more information, the better!" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>