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PNS Travels

Patricia - Nadirah - Sakeenah

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		<field type="header" subtype="h1" label="Booking Inquiry Form"/>&#13;
		<field type="paragraph" subtype="p" label="Please fill out this form to request travel services from PNS Travels.&amp;nbsp; If you have any questions, you can e-mail Sakeenah@PNSTravelsLLC.com or call (443) 502-0441."/>&#13;
		<field type="text" required="true" label="First Name&amp;nbsp;" 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="Telephone Number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth" name="birthday" className="form-control"/>&#13;
		<field type="text" label="State of Primary Residence" name="state-of-primary-residence" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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" 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="text" required="true" label="What is your departure and return 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?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are any travelers children under 18? If so, please list age(s) at time of trip." name="are-any-travelers-children-if-so-please-list-age-at-time-of-trip-or-dob" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What type of travel accommodations are you seeking?" name="what-type-of-trip-do-you-prefer" other="true">&#13;
			<option label="Hotel Only" value="hotel-only">Hotel Only</option>&#13;
			<option label="Flight &amp; Hotel" value="flight-hotel">Flight &amp; Hotel</option>&#13;
			<option label="Flight, Hotel &amp; Rental Car" value="flight-hotel-rental-car">Flight, Hotel &amp; Rental Car</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#13;
		<field type="text" label="Desired Budget (Per Person)" name="text-1734902533404" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Is this a trip celebrating a special occasion?" name="is-this-a-special-occasion-please-check-the-appropriate-box">&#13;
			<option label="Bachelor/Bachelorette Party" value="bachelorbachelorette-party">Bachelor/Bachelorette Party</option>&#13;
			<option label="Birthday Celebration" value="birthday-celebration">Birthday Celebration</option>&#13;
			<option label="Honeymoon/Anniversary" value="honeymoonanniversary">Honeymoon/Anniversary</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#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;
	</fields>&#13;
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  </body>
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