Barry Goodwin

Optimize Travel LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Client &amp;amp; Trip Information Form:"/>&#13;
		<field type="header" subtype="h1" label="Contact 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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Information:"/>&#13;
		<field type="text" required="true" label="Departing From:" description="Where are you traveling from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Going To?" 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="date" required="true" label="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" required="true" label="Return Date:&amp;nbsp;" 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" required="true" label="Are your dates flexible?" inline="true" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Select Your Accommodation:"/>&#13;
		<field type="checkbox-group" required="true" label="Check all that applies" description="Check ALL that apply" inline="true" name="check-all-that-applies">&#13;
			<option label="Flight" value="flight">Flight</option>&#13;
			<option label="Hotel/Resort" value="hotelresort">Hotel/Resort</option>&#13;
			<option label="Vacation Home" value="vacation-home">Vacation Home</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Cabin" value="cabin">Cabin</option>&#13;
			<option label="Rental Car/Truck" value="rental-cartruck">Rental Car/Truck</option>&#13;
			<option label="Villa" value="villa">Villa</option>&#13;
			<option label="Corporate Villa" value="corporate-villa">Corporate Villa</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="# of adult travelers:" inline="true" name="-of-travelers">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5+" value="5">5+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="# of children travelers:" inline="true" name="radio-group-1733709302778">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5+" value="5">5+</option>&#13;
		</field>&#13;
		<field type="text" label="If this is a group? Estimated group travelers.&amp;nbsp;" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Protect Your Trip:"/>&#13;
		<field type="radio-group" required="true" label="Would you like to add &quot;Travel Protection&quot; for peace of mind against unexpected changes or emergencies? (Highly Recommended)" inline="true" name="do-you-want-travel-protection-highly-recommended">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Unsure Right Now" value="unsure-right-now">Unsure Right Now</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Preferences:"/>&#13;
		<field type="radio-group" label="Flights - Seat preference" inline="true" name="seat-preference">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Middle" value="middle">Middle</option>&#13;
			<option label="Aisle" value="aisle">Aisle</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Bed preference" inline="true" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Interior - Cruise" value="interior-cruise">Interior - Cruise</option>&#13;
			<option label="Ocean View - Cruise" value="ocean-view-cruise">Ocean View - Cruise</option>&#13;
			<option label="Balcony - Cruise" value="balcony-cruise">Balcony - Cruise</option>&#13;
			<option label="Suite - Cruise" value="suite-cruise">Suite - Cruise</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Rental car preference" inline="true" name="rental-car-preference">&#13;
			<option label="Car" value="car">Car</option>&#13;
			<option label="SUV" value="suv">SUV</option>&#13;
			<option label="Truck" value="truck">Truck</option>&#13;
			<option label="Van" value="van">Van</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your accommodation preference?" inline="true" name="hotel-preference">&#13;
			<option label="2 - Star" value="2-star">2 - Star</option>&#13;
			<option label="3 - Star" value="3-star">3 - Star</option>&#13;
			<option label="4 - Star" value="4-star">4 - Star</option>&#13;
			<option label="5 - Star" value="5-star">5 - Star</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Preferred Budget:"/>&#13;
		<field type="radio-group" required="true" label="What is your budget per traveler?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$850 to $1,500" value="850-to-1500">$850 to $1,500</option>&#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-to-10000">$8,500 to $10,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." inline="true" 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;
			<option label="Guided Tours" value="guided-tours">Guided Tours</option>&#13;
		</field>&#13;
		<field type="text" label="Please specify if &quot;other&quot; is selected" name="please-specify-if-other-is-selected" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Activities"/>&#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;
			<option label="Tours" value="tours">Tours</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Extras"/>&#13;
		<field type="radio-group" label="T-Shirt Size" inline="true" name="tshirt-size">&#13;
			<option label="XS" value="xs">XS</option>&#13;
			<option label="S" value="s">S</option>&#13;
			<option label="M" value="m">M</option>&#13;
			<option label="L" value="l">L</option>&#13;
			<option label="XL" value="xl">XL</option>&#13;
			<option label="XXL" value="xxl">XXL</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Stay Connected &amp;amp; Join Our Email List"/>&#13;
		<field type="radio-group" required="true" label="Would you like to join our email list to receive newsletters, exclusive promotions, and a chance to win free monthly giveaways?" name="do-you-want-to-optedin-for-our-email-list-to-receive-newsletters-promotions-and-a-chance-to-receive-free-monthly-giveaways-">&#13;
			<option label="Opt-In &quot;Yes, I want to receive newsletters, promotions, and giveaways!&quot;" value="optin-yes-i-want-to-receive-newsletters-promotions-and-giveaways">Opt-In "Yes, I want to receive newsletters, promotions, and giveaways!"</option>&#13;
			<option label="Opt-Out &quot;No, I do not wish to receive newsletters or promotional emails.&quot;" value="optout-no-i-do-not-wish-to-receive-newsletters-or-promotional-emails">Opt-Out "No, I do not wish to receive newsletters or promotional emails."</option>&#13;
		</field>&#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>