Share your information with Leah Brewer

Leah Brewer

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Client Inquiry"/>&#13;
		<field type="text" required="true" label="First name" 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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What kind of vacation are you looking for?" name="radio-group-1767746520757" other="true">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All Inclusive Resort/Caribbean" value="all-inclusive-resortcaribbean">All Inclusive Resort/Caribbean</option>&#13;
			<option label="Disney Parks" value="disney-parks">Disney Parks</option>&#13;
			<option label="Universal Parks" value="universal-parks">Universal Parks</option>&#13;
			<option label="Europe/Asia" value="europeasia">Europe/Asia</option>&#13;
		</field>&#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;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Ages of travelers:" name="text-1767747356143" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your total budget?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="Budget friendly: max $2k" value="budget-friendly-max-2k">Budget friendly: max $2k</option>&#13;
			<option label="Moderate: max $3k-$4k" value="moderate-max-3k4k">Moderate: max $3k-$4k</option>&#13;
			<option label="Little splurge: max $4k-$6k" value="little-splurge-max-4k6k">Little splurge: max $4k-$6k</option>&#13;
			<option label="Big splurge: max $6k-$8k" value="big-splurge-max-6k8k">Big splurge: max $6k-$8k</option>&#13;
			<option label="Luxury: $8k+" value="luxury-8k">Luxury: $8k+</option>&#13;
			<option label="No Budget" value="no-budget">No Budget</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="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="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?&amp;nbsp;" 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="checkbox-group" label="How soon are you looking to book?" name="checkbox-group-1767746336992">&#13;
			<option label="ASAP!" value="asap">ASAP!</option>&#13;
			<option label="Within next 7-10 days" value="within-next-710-days">Within next 7-10 days</option>&#13;
			<option label="In a few months" value="in-a-few-months">In a few months</option>&#13;
			<option label="Just considering options" value="just-considering-options">Just considering options</option>&#13;
		</field>&#13;
		<field type="text" label="Who can I thank for connecting you with me?" name="text-1770768890629" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>