Share your information with Jose Gonzalez

Jose Gonzalez

Going Places With Gonzo, Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let&#39;s Get You Going Places!"/>&#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="text" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" 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="radio-group" required="true" label="What type of vacation are you looking for?" name="what-type-of-vacation-are-you-looking-for" other="true">&#13;
			<option label="Theme Park" value="theme-park">Theme Park</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Contiguous Domestic United States" value="contiguous-domestic-united-states">Contiguous Domestic United States</option>&#13;
			<option label="Alaska/Alaskan Cruise" value="alaskaalaskan-cruise">Alaska/Alaskan Cruise</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="European" value="european">European</option>&#13;
			<option label="Other International Destination" value="other-international-destination">Other International Destination</option>&#13;
		</field>&#13;
		<field type="text" 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" 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="text" 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" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Please list how many adults and how many kids along with the ages of each child." name="please-list-how-many-adults-and-how-many-kids-along-with-the-ages-of-each-child" subtype="text" 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-$15,000" value="1000015000">$10,000-$15,000</option>&#13;
			<option label="$15,000-$20.000" value="1500020000">$15,000-$20.000</option>&#13;
			<option label="$20,000+" value="20000">$20,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Does everyone in your party have a passport that expires at least 6 months after your preferred dates of travel?" name="does-everyone-in-your-party-have-a-passport-that-expires-at-least-6-months-after-your-preferred-dates-of-travel">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have any accessibility needs?" name="do-you-have-any-accessibility-needs" subtype="text" className="form-control"/>&#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="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" 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="radio-group" label="Are you celebrating anything special?" name="are-you-celebrating-anything-special">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Promotion" value="promotion">Promotion</option>&#13;
			<option label="Just Life and Family!" value="just-life-and-family">Just Life and Family!</option>&#13;
		</field>&#13;
		<field type="select" label="How soon are you hoping to book your travels?" name="how-soon-are-you-hoping-to-book-your-travels" className="form-control">&#13;
			<option label="As soon as possible." value="as-soon-as-possible">As soon as possible.</option>&#13;
			<option label="In the next 2 weeks-1 month" value="in-the-next-2-weeks1-month">In the next 2 weeks-1 month</option>&#13;
			<option label="In the next 1-3 months" value="in-the-next-13-months">In the next 1-3 months</option>&#13;
			<option label="Sometime in the next 3-6 months" value="sometime-in-the-next-36-months">Sometime in the next 3-6 months</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;
		<field type="text" label="Who can I thank for referring you to me?" name="who-can-i-thank-for-referring-you-to-me" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>