Share your information with Brandi K / Shanice D

Brandi K / Shanice D

Black Pearls Travel

<html>
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    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" label="Where would you like to travel?" 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="text" label="What is your departure city?" placeholder="ex: Atlanta, GA" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Preferred Departure Date" 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="Preferred Return Date" 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?" placeholder="ex : 1 adult + 2 children" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Do all travelers have valid passports valid for at least 6 months beyond travel?" name="checkbox-group-1782236919720">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="Some Do" value="some-do">Some Do</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Domestic Travel Only" value="domestic-travel-only">Domestic Travel Only</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your total trip budget (including flights, hotel/cruise, and transfers)?" 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="checkbox-group" label="What stage are you in?" name="checkbox-group-1782237554563">&#13;
			<option label="Ready to book now" value="ready-to-book-now">Ready to book now</option>&#13;
			<option label="Booking within 30 days" value="booking-within-30-days">Booking within 30 days</option>&#13;
			<option label="Booking within 3 months" value="booking-within-3-months">Booking within 3 months</option>&#13;
			<option label="Just exploring options" value="just-exploring-options">Just exploring options</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="Is there anything you absolutely must do, see, or experience?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like us to know about your trip?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Last But Not Least, How Did You Hear About Us?" name="checkbox-group-1782237663022" other="true">&#13;
			<option label="Previous Client" value="previous-client">Previous Client</option>&#13;
			<option label="Friend/Family Referral" value="friendfamily-referral">Friend/Family Referral</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Event/Festival" value="eventfestival">Event/Festival</option>&#13;
		</field>&#13;
		<field type="text" label="If someone referred you, who may we thank?" name="text-1782237788995" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>