<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Client Information"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="textarea" required="true" label="Please list all additional travelers with their full names and birthdays as they appear on their passports." name="please-list-all-additional-travelers-with-their-full-names-and-birthdays-as-they-appear-on-their-passports" className="form-control"/> <field type="text" label="Would you like to add anyone to our communications? Please list their name(s) and email(s) below." name="would-you-like-to-add-anyone-to-our-communications-please-list-their-names-and-emails-below" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="About Your Trip"/> <field type="date" required="true" label="What's the earliest you can depart?" name="whats-the-earliest-you-can-depart" className="form-control"/> <field type="date" required="true" label="What's the latest you can return?" name="whats-the-latest-you-can-return" className="form-control"/> <field type="radio-group" required="true" label="Are your dates flexible?" name="are-your-dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="How many nights would you like the cruise to be (this can be a range)?" name="how-many-nights-would-you-like-the-cruise-to-be-this-can-be-a-range" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Would you like to include airfare?" description="*We only book business class and above" name="would-you-like-to-include-airfare"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="If you would like to include business class and above airfare, which airport would you be departing from?" name="if-you-would-like-to-include-airfare-which-airport-would-you-be-departing-from" subtype="text" className="form-control"/> <field type="text" label="Are you celebrating anything special?" name="are-you-celebrating-anything-special" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Is this your first river cruise?" name="is-this-your-first-cruise"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Please check any of the following river cruise companies that you are interested in:" name="please-check-any-of-the-following-river-cruise-companies-that-you-are-interested-in" other="true"> <option label="Viking" value="viking">Viking</option> <option label="AmaWaterways" value="amawaterways">AmaWaterways</option> <option label="Avalon Waterways" value="avalon-waterways">Avalon Waterways</option> <option label="Uniworld" value="uniworld">Uniworld</option> <option label="Tauck River Cruises" value="tauck-river-cruises">Tauck River Cruises</option> <option label="Scenic" value="scenic">Scenic</option> </field> <field type="textarea" label="Please list below if there are any cruise lines you would like to avoid:" name="please-list-below-if-there-are-any-cruise-lines-you-would-like-to-avoid" rows="3" className="form-control"/> <field type="checkbox-group" required="true" label="Please select the area(s) that you are most interested in visiting:" name="please-select-the-areas-that-you-are-most-interested-in-visiting"> <option label="Danube (Germany, Austria, Hungry, Budapest" value="danube-germany-austria-hungry-budapest">Danube (Germany, Austria, Hungry, Budapest</option> <option label="Douro (Portugal/Spain)" value="douro-portugalspain">Douro (Portugal/Spain)</option> <option label="France (Normandy, Bordeaux, Provence)" value="france-normandy-bordeaux-provence">France (Normandy, Bordeaux, Provence)</option> <option label="Rhine (Switzerland, Germany, the Netherlands)" value="rhine-switzerland-germany-the-netherlands">Rhine (Switzerland, Germany, the Netherlands)</option> <option label="Elbe (Germany and Czech Republic)" value="elbe-germany-and-czech-republic">Elbe (Germany and Czech Republic)</option> <option label="Multi Country (10+ Day Itineraries)" value="multi-country-10-day-itineraries">Multi Country (10+ Day Itineraries)</option> <option label="Christmas Markets (November-December Only)" value="christmas-markets-novemberdecember-only">Christmas Markets (November-December Only)</option> <option label="Tulip Season (Mid March- May)" value="tulip-season-mid-march-may">Tulip Season (Mid March- May)</option> <option label="Mekong (Asia)" value="mekong-asia">Mekong (Asia)</option> <option label="Egypt" value="egypt">Egypt</option> </field> <field type="radio-group" required="true" label="What is your minimum budget starting with 2 people in a cabin that you are comfortable with for the CRUISE ONLY?" description="*When looking online or at a brochure please keep in mind that pricing is listed as a per person cost*" name="what-is-your-minimum-budget-starting-with-2-people-in-a-cabin-that-you-are-comfortable-with-for-the-cruise-only" other="true"> <option label="Whatever it takes to create the experience I am looking for" value="whatever-it-takes-to-create-the-experience-i-am-looking-for">Whatever it takes to create the experience I am looking for</option> <option label="$25,000+" value="25000">$25,000+</option> <option label="$15,000-$25,000" value="1500025000">$15,000-$25,000</option> <option label="$10,000-$15,000" value="1000015000">$10,000-$15,000</option> </field> <field type="textarea" label="Is there anything else I should know about your price range?" name="is-there-anything-else-i-should-know-about-your-price-range" className="form-control"/> <field type="header" subtype="h1" label="Your Preferences&nbsp;"/> <field type="text" required="true" label="Are you interested in a Pre-Stay or Post-Stay (list how many days either before or after you would like to arrive to cruise- or if you’d to visit other locations prior to embarking&nbsp; on your cruise)" name="are-you-interested-in-a-prestay-or-poststay-list-how-many-days-either-before-or-after-you-would-like-to-arrive-to-cruise-or-if-youd-to-visit-other-locations-prior-to-embarking-on-your-cruise" subtype="text" className="form-control"/> <field type="radio-group" label="Pre &amp; Post Stay In Destination - If Applicable" description="Please note we recommend arriving into destination at least 1 day before embarking on your river cruise to ensure an on-time departure" name="pre-post-stay-in-destination-if-applicable" other="true"> <option label="I am interested in bundling a pre or post stay with my river cruise booking" value="i-am-interested-in-bundling-a-pre-or-post-stay-with-my-river-cruise-booking">I am interested in bundling a pre or post stay with my river cruise booking</option> <option label="I would prefer to book it separately to further customize my pre or post stay." value="i-would-prefer-to-book-it-separately-to-further-customize-my-pre-or-post-stay">I would prefer to book it separately to further customize my pre or post stay.</option> </field> <field type="radio-group" required="true" label="Which option would you prefer while pricing out options?" name="which-option-would-you-prefer-while-pricing-out-options" other="true"> <option label="All-Inclusive Pricing at time of booking (to included things like pre paid gratuities, all tours, unlimited drinks)" value="allinclusive-pricing-at-time-of-booking-to-included-things-like-pre-paid-gratuities-all-tours-unlimited-drinks">All-Inclusive Pricing at time of booking (to included things like pre paid gratuities, all tours, unlimited drinks)</option> <option label="I would rather pay less initially and include things once onboard (gratuities, specialty drinks, upgraded tour options) ((beer and wine will be served at meals and each stop will include a complimentary tour, however additional tour options/experiences are available for an upcharge))" value="i-would-rather-pay-less-initially-and-include-things-once-onboard-gratuities-specialty-drinks-upgraded-tour-options-beer-and-wine-will-be-served-at-meals-and-each-stop-will-include-a-complimentary-tour-however-additional-tour-optionsexperiences-are-available-for-an-upcharge">I would rather pay less initially and include things once onboard (gratuities, specialty drinks, upgraded tour options) ((beer and wine will be served at meals and each stop will include a complimentary tour, however additional tour options/experiences are available for an upcharge))</option> </field> <field type="checkbox-group" required="true" label="What type of cabin are you interested in?" description="You can choose multiple options for pricing. Please note cabins are made to accommodate two people only and they do not have connecting cabins." name="what-type-of-cabin-are-you-interested-in" other="true"> <option label="Veranda Suite" value="veranda-suite">Veranda Suite</option> <option label="Veranda (Balcony)" value="veranda-balcony">Veranda (Balcony)</option> <option label="French Balcony (Juliet Balcony)" value="french-balcony-juliet-balcony">French Balcony (Juliet Balcony)</option> <option label="Standard (window only)" value="standard-window-only">Standard (window only)</option> </field> <field type="textarea" label="Is there anyone in your party who struggles with mobility? If so, please explain further so we can best assist.&nbsp;" name="what-else-would-you-like-me-to-know-dietary-or-medical-requirements-special-requests-etc" rows="2" className="form-control"/> <field type="header" subtype="h1" label="Final Notes To Further Customize Your Travel&nbsp;"/> <field type="radio-group" required="true" label="I understand Professional Planning Fees are associated based on the level of services required. This will be discussed on your complimentary planning call with your agent." name="i-understand-professional-planning-fees-are-associated-based-on-the-level-of-services-required-please-note-that-we-have-a-fee-structure-for-our-professional-planning-services-these-fees-vary-based-on-the-type-of-trip-and-level-of-service-required-this-will-be-discussed-on-your-complimentary-planning-call-with-your-agent"> <option label="Yes, I understand" value="yes-i-understand">Yes, I understand</option> <option label="I'm confused, please explain further" value="im-confused-please-explain-further">I'm confused, please explain further</option> </field> <field type="textarea" label="Anything else you'd like me to know about your trip?" name="anything-else-youd-like-me-to-know-about-your-trip" rows="3" className="form-control"/> </fields> </form-template> </body> </html>
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