Stacey Roussel

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Cruise Quote"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" 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="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Let's Cruise!"/>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="text" label="Where would you like to cruise? Any must see ports?" name="where-would-you-like-to-cruise-any-must-see-ports" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your total budget for all travelers?" description="This just gives me a starting point.  It can be adjusted as we go." inline="true" name="what-is-your-total-budget-for-all-travelers" other="true">&#13;
			<option label="$2,000-$4,000" value="20004000">$2,000-$4,000</option>&#13;
			<option label="$4,000-$6,000" value="40006000">$4,000-$6,000</option>&#13;
			<option label="$6,000-$8,500" value="60008500">$6,000-$8,500</option>&#13;
			<option label="$8,500+" value="8500">$8,500+</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="You are only providing info for the people on your reservation. If traveling with a group, each family will fill out their own form."/>&#13;
		<field type="textarea" required="true" label="Adults Traveling? Please provide all NAMES and DOB as they are listed on Passports or Government issued ID and birth certificates.&amp;nbsp;" name="how-many-adultschildren-are-traveling-please-provide-all-names-and-birthdates-as-they-are-listed-on-passports-or-government-issued-id-and-birth-certificates-" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Children Traveling? Please provide all NAMES and DOB as they are listed on Passports or Government issued ID and birth certificates.&amp;nbsp;" name="how-many-children-are-traveling-please-provide-all-names-and-birthdates-as-they-are-listed-on-passports-or-government-issued-id-and-birth-certificates-" className="form-control"/>&#13;
		<field type="text" required="true" label="How many cabins do you require?" description="If no children are going  please put a 0 or N/A." name="how-many-children-are-traveling-and-what-are-the-ages-at-the-time-of-travel" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" label="Length of Cruise" name="length-of-cruise">&#13;
			<option label="2-5  days" value="25-days">2-5  days</option>&#13;
			<option label="6-9 days" value="69-days">6-9 days</option>&#13;
			<option label="10+ days" value="10-days">10+ days</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Where would you like your cabin?" name="where-would-you-like-your-cabin">&#13;
			<option label="Forward" value="forward">Forward</option>&#13;
			<option label="Middle" value="middle">Middle</option>&#13;
			<option label="Aft(back)" value="aftback">Aft(back)</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Which side of the boat do you prefer?" name="which-side-of-the-boat-do-you-prefer">&#13;
			<option label="Right" value="right">Right</option>&#13;
			<option label="Left" value="left">Left</option>&#13;
			<option label="No Preference" value="no-preference">No Preference</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What deck do you &amp;nbsp;want to be on?" name="what-deck-do-you-want-to-be-on">&#13;
			<option label="Lower" value="lower">Lower</option>&#13;
			<option label="Middle" value="middle">Middle</option>&#13;
			<option label="Upper" value="upper">Upper</option>&#13;
			<option label="Least expenisve deck" value="least-expenisve-deck">Least expenisve deck</option>&#13;
			<option label="No preference" value="no-preference">No preference</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Type of Cabin" name="type-of-cabin">&#13;
			<option label="Balcony Suite" value="balcony-suite">Balcony Suite</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Does anyone in your party require an Accessible Room?" name="does-anyone-in-your-party-require-an-accessible-room" other="true">&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Yes, hearing accessible" value="yes-hearing-accessible">Yes, hearing accessible</option>&#13;
			<option label="Yes, mobility accessible" value="yes-mobility-accessible">Yes, mobility accessible</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Any Special Occasions?" description="Will you be celebrating anything while on the cruise?" name="any-special-occasions" other="true">&#13;
			<option label="Graduation" value="graduation">Graduation</option>&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Engagement" value="engagement">Engagement</option>&#13;
			<option label="Wedding" value="wedding">Wedding</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Bachelorette Party" value="bachelorette-party">Bachelorette Party</option>&#13;
			<option label="Bachelor Party " value="bachelor-party-">Bachelor Party </option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Babymoon" value="babymoon">Babymoon</option>&#13;
			<option label="Family Reunion" value="family-reunion">Family Reunion</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Do you need flights, hotels or land tour packages as part of this vacation?" description="Please select all that apply." name="do-you-need-flights-hotels-or-land-tour-packages-as-part-of-this-vacation" multiple="multiple" className="form-control">&#13;
			<option label="No Hotel or Flight Needed" value="no-hotel-or-flight-needed">No Hotel or Flight Needed</option>&#13;
			<option label="Pre-Cruise Hotel" value="precruise-hotel">Pre-Cruise Hotel</option>&#13;
			<option label="Post-Cruise Hotel" value="postcruise-hotel">Post-Cruise Hotel</option>&#13;
			<option label="Roundtrip Flights" value="roundtrip-flights">Roundtrip Flights</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do all members of your party currently have passports?" name="do-all-members-of-your-party-currently-have-passports">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Working on it" value="working-on-it">Working on it</option>&#13;
		</field>&#13;
		<field type="text" label="Preference in Cruiseline?" name="preference-in-cruiseline" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" description="Please enter any loyalty numbers relevant to this trip." 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="Anything else you'd like me to know? &amp;nbsp;" name="anything-youd-like-me-to-know" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you working with any other Travel Agents?" name="are-you-working-with-any-other-travel-agents">&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Do you need travel insurance?" name="do-you-need-travel-insurance">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>