<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Travel Inquiry&nbsp;"/> <field type="select" label="Select Travel Agent&nbsp;" description="Select Agent" name="select-travel-agent-" className="form-control"> <option label="Deb Haynes " value="deb-haynes-">Deb Haynes </option> <option label="Alicen Stoker " value="alicen-stoker-">Alicen Stoker </option> <option label="Jen Sampson " value="jen-sampson-">Jen Sampson </option> <option label="Beth Lanctot " value="beth-lanctot-">Beth Lanctot </option> <option label="Bailey Massender " value="bailey-massender-">Bailey Massender </option> <option label="Ann Gillet" value="ann-gillet">Ann Gillet</option> </field> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Do you have a passport?" description="Important: Please check your passport expiration date as passports must be valid for 6 months after travel. If you are in need of a new or renewed passport Go Wander Travel Co. will require confirmation of application prior to contracting services." inline="true" name="do-you-have-a-passport"> <option label="YES" value="YES">YES</option> <option label="NO" value="NO">NO</option> </field> <field type="checkbox-group" required="true" label="Is everyone in your travel party fully vaccinated against COVID-19? Vaccination status may impact travel destinations and protocols." description="As travel requirements continue to evolve knowing this information allows me to provide a better guidance in the trip planning process." name="is-everyone-in-your-travel-party-fully-vaccinated-against-covid19-vaccination-status-may-impact-travel-destinations-and-protocols"> <option label="Yes" value="Yes">Yes</option> <option label="No" value="No">No</option> </field> <field type="text" required="true" label="Preferred Departure City/Airport(s):" description="List multiple if necessary" name="preferred-departure-cityairports" subtype="text" className="form-control"/> <field type="text" required="true" label="Where would you like to go?" description="Destination do you have in mind for this trip?" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <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"/> <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"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" label="How many days do you want to go on vacation?" name="departure-city" subtype="text" className="form-control"/> <field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="textarea" label="For multiple travelers." description="Tell me a little bit about who you are traveling with." placeholder="Example: "I am traveling with my husband and two children ages 5 and 6."" name="for-multiple-travelers" className="form-control"/> <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"> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option> <option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option> <option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option> <option label="$10,000+" value="10000">$10,000+</option> </field> <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <field type="textarea" label="What else would you like me to know about your vacation preference ?" name="notes" className="form-control"/> <field type="checkbox-group" label="&nbsp;For this trip, which best describes where are you at in the planning process?*" name="-for-this-trip-which-best-describes-where-are-you-at-in-the-planning-process"> <option label="I'm just exploring my options and am not planning on booking anything anytime soon." value="im-just-exploring-my-options-and-am-not-planning-on-booking-anything-anytime-soon">I'm just exploring my options and am not planning on booking anything anytime soon.</option> <option label="I'm ready to begin planning my trip and would like to book sometime in the near future." value="im-ready-to-begin-planning-my-trip-and-would-like-to-book-sometime-in-the-near-future">I'm ready to begin planning my trip and would like to book sometime in the near future.</option> <option label="I already know exactly what I want and want to book my trip ASAP." value="i-already-know-exactly-what-i-want-and-want-to-book-my-trip-asap">I already know exactly what I want and want to book my trip ASAP.</option> </field> <field type="radio-group" required="true" label="Have you ever worked with&nbsp; a travel advisor?" name="have-you-ever-worked-with-a-travel-advisor"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="How did you hear about Debz Travel At-Ease LLC ?" description="Referral from family/friend/social media" name="how-did-you-hear-about-debz-travel-atease-llc-" subtype="text" className="form-control"/> <field type="text" label="If referred by someone, please let me know their name so I can thank them!&nbsp;" name="if-referred-by-someone-please-let-me-know-their-name-so-i-can-thank-them-" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="By submitting this form, I agree to Debz Travel At-Ease LLC., collecting the information provided and consent to being contacted regarding this request. I understand that&nbsp; Debz Travel At-Ease LLC charges a research/planning fee for services, which will be determined following my consultation." name="by-submitting-this-form-i-agree-to-debz-travel-atease-llc-collecting-the-information-provided-and-consent-to-being-contacted-regarding-this-request-i-understand-that-debz-travel-atease-llc-charges-a-researchplanning-fee-for-services-which-will-be-determined-following-my-consultation"> <option label="I Agree" value="i-agree">I Agree</option> </field> </fields> </form-template> </body> </html>
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