Kerry Thompson

Brite Travels by MainStreet Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Destination"/>&#13;
		<field type="text" 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="header" subtype="h2" label="Lead Traveler Information"/>&#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="date" label="Birthday" name="birthday" 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="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="date" 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" 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" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What type of Vacation?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Disney World" value="disney-world">Disney World</option>&#13;
			<option label="Dinseyland" value="dinseyland">Dinseyland</option>&#13;
			<option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Royal Caribbean Cruise" value="royal-caribbean-cruise">Royal Caribbean Cruise</option>&#13;
			<option label="Viking River or Ocean Cruise" value="viking-river-or-ocean-cruise">Viking River or Ocean Cruise</option>&#13;
			<option label="Other Cruise" value="other-cruise">Other Cruise</option>&#13;
			<option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option>&#13;
			<option label="Hotel Accomodations" value="hotel-accomodations">Hotel Accomodations</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Names and Birthdates of all Travelers" name="names-and-birthdates-of-all-travelers" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 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="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How much do you know about your destination?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Nothing at All, Hold my hand through everything" value="nothing-at-all-hold-my-hand-through-everything">Nothing at All, Hold my hand through everything</option>&#13;
			<option label="Just a bit, I need help" value="just-a-bit-i-need-help">Just a bit, I need help</option>&#13;
			<option label="Moderate amount, guidance will be enough" value="moderate-amount-guidance-will-be-enough">Moderate amount, guidance will be enough</option>&#13;
			<option label="Just book it, I will do everything else.  I know what I am doing!" value="just-book-it-i-will-do-everything-else-i-know-what-i-am-doing">Just book it, I will do everything else.  I know what I am doing!</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" 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;
	</fields>&#13;
</form-template>
  </body>
</html>