Share your information with Latetra Rorie

Latetra Rorie

FabuLuxe Escapes Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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="date" required="true" label="Birthday" name="birthday" 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="text" required="true" label="Where would you like to go?" 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="date" required="true" 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" required="true" 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="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget per traveler?&amp;nbsp;" 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;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you deposit ready?" name="are-you-deposit-ready">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Next week" value="next-week">Next week</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do you want travel protection?" name="do-you-want-travel-protection">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Will you need a payment plan?" name="will-you-need-a-payment-plan">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</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;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Desired vacation experience" name="desired-vacation-experience">&#13;
			<option label="All- Inclusive" value="all-inclusive">All- Inclusive</option>&#13;
			<option label="Adult Only All-Inclusive" value="adult-only-allinclusive">Adult Only All-Inclusive</option>&#13;
			<option label="Mountain Cabin Trip" value="mountain-cabin-trip">Mountain Cabin Trip</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Rest and Relaxation" value="rest-and-relaxation">Rest and Relaxation</option>&#13;
			<option label="Cruise" value="cruise">Cruise</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="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of guest rooms needed" name="number-of-guest-rooms-needed" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of adults in each room" name="number-of-adults-in-each-room" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of children traveling?" name="number-of-children-traveling" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please list the ages of all children" name="please-list-the-ages-of-all-children" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Do all travelers have passports?" name="do-all-travelers-have-passports">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Waiting for arrival" value="waiting-for-arrival">Waiting for arrival</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Passport Info"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#13;
		<field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Flight Information (Only complete if flights are needed)&amp;nbsp; Please provide your preferred departure airport code.&amp;nbsp; Ex. (Charlotte-CLT, Atlanta-ATL)" name="flight-information-only-complete-if-flights-are-needed-please-provide-your-preferred-departure-airport-code" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="&amp;nbsp; Please provide your preferred&amp;nbsp; airline" name="-please-provide-your-preferred-departure-airport-or-airport-code">&#13;
			<option label="American Airlines" value="american-airlines">American Airlines</option>&#13;
			<option label="Delta Airlines" value="delta-airlines">Delta Airlines</option>&#13;
			<option label="Southwest Airlines" value="southwest-airlines">Southwest Airlines</option>&#13;
			<option label="Frontier Airlines" value="frontier-airlines">Frontier Airlines</option>&#13;
			<option label="Spirit Airlines" value="spirit-airlines">Spirit Airlines</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/>&#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>