Share your information with Teghan Sullivan

Teghan Sullivan

Luma Travel Co.

<html>
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		<field type="header" subtype="h1" label="CLIENT INFORMATION"/>&#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" required="true" label="Preferred Name:" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address:" 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="text" label="Street Address:" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City:" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State:" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip:" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="ABOUT YOUR TRIP"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes - I am flexible based on availability" value="yes-i-am-flexible-based-on-availability">Yes - I am flexible based on availability</option>&#13;
			<option label="No - I have specific dates that I must maintain" value="no-i-have-specific-dates-that-i-must-maintain">No - I have specific dates that I must maintain</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city? Preferred starting airport?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is this vacation to celebrate anything special?" name="is-this-vacation-to-celebrate-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Who all will be traveling with you? Please list all full names (including middle) and birthdates, as listed on passport." name="who-all-will-be-traveling-with-you-please-list-all-full-names-including-middle-and-birthdates-as-listed-on-passport" className="form-control"/>&#13;
		<field type="radio-group" label="At what phase of planning are you currently in?" name="at-what-phase-of-planning-are-you-in">&#13;
			<option label="I’m just beginning the planning process" value="im-just-beginning-the-planning-process">I’m just beginning the planning process</option>&#13;
			<option label="We have dates, but no other details confirmed" value="we-have-dates-but-no-other-details-confirmed">We have dates, but no other details confirmed</option>&#13;
			<option label="We have hotels and flights already booked" value="we-have-hotels-and-flights-already-booked">We have hotels and flights already booked</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for the trip?&amp;nbsp;" name="what-is-your-budget-for-all-travelers-this-just-gives-me-a-general-starting-point-and-can-always-be-changed-later">&#13;
			<option label="$3,000 - $5,000" value="3000-5000">$3,000 - $5,000</option>&#13;
			<option label="$5,000 - $7,000" value="5000-7000">$5,000 - $7,000</option>&#13;
			<option label="$7,000 - $10,000" value="7000-10000">$7,000 - $10,000</option>&#13;
			<option label="$10,000 - $15,000" value="10000-15000">$10,000 - $15,000</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
		</field>&#13;
		<field type="textarea" label="Will you be booking any portion of your trip with points? If so, which pieces?" name="will-you-be-booking-any-portion-of-your-trip-with-points-if-so-which-pieces" className="form-control"/>&#13;
		<field type="checkbox-group" label="What travel components would you like us to assist you with? Check all that apply." name="what-travel-components-would-you-like-us-to-assist-you-with-check-all-that-apply">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Transportation (car rental, trains, etc.)" value="transportation-car-rental-trains-etc">Transportation (car rental, trains, etc.)</option>&#13;
			<option label="Excursions &amp; tours" value="excursions-tours">Excursions &amp; tours</option>&#13;
			<option label="Insurance" value="insurance">Insurance</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your desired accommodation style?" name="what-best-describes-your-desired-accommodation-style">&#13;
			<option label="Luxury &amp; exclusive" value="luxury-exclusive">Luxury &amp; exclusive</option>&#13;
			<option label="Boutique &amp; charming" value="boutique-charming">Boutique &amp; charming</option>&#13;
			<option label="Centrally located  &amp; functional" value="centrally-located-functional">Centrally located  &amp; functional</option>&#13;
			<option label="Large resort" value="large-resort">Large resort</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="What are your amenity “must haves”? Is there anything you would want your hotels to have such as a pool, on-site restaurant, bar, etc.?" name="what-are-your-amenity-musthaves-" className="form-control"/>&#13;
		<field type="checkbox-group" label="What options best describe your travel priorities? Check all that apply." name="what-options-best-describe-your-travel-priorities-checkbox-group">&#13;
			<option label="Local culture &amp; education" value="local-culture-education">Local culture &amp; education</option>&#13;
			<option label="Art &amp; architecture" value="art-architecture">Art &amp; architecture</option>&#13;
			<option label="Food &amp; wine" value="food-wine">Food &amp; wine</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="Dramatic views &amp; landscapes" value="dramatic-views-landscapes">Dramatic views &amp; landscapes</option>&#13;
			<option label="Spa &amp; wellness" value="spa-wellness">Spa &amp; wellness</option>&#13;
			<option label="Rest &amp; relaxation" value="rest-relaxation">Rest &amp; relaxation</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know about your ideal vacation?&amp;nbsp;" name="describe-your-vision-for-your-ideal-vacation" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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