Share your information with Gibbs Miller

Gibbs Miller

Gay Gillen Travel

<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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" 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" 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" 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="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a favorite hotel brand or hotel that you have stayed at in the past?" name="do-you-have-a-favorite-hotel-brand-or-hotel-that-you-have-stayed-at-in-the-past" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Excluding international air travel, what is your budget for all travelers?" name="excluding-international-air-travel-what-is-your-budget-for-all-travelers">&#13;
			<option label="$10,000 - $20,000" value="10000-20000">$10,000 - $20,000</option>&#13;
			<option label="$20,000 - $25,000" value="20000-25000">$20,000 - $25,000</option>&#13;
			<option label="$25,000 - $30,000" value="25000-30000">$25,000 - $30,000</option>&#13;
			<option label="$30,000+" value="30000">$30,000+</option>&#13;
		</field>&#13;
		<field type="text" label="Please describe the overall feel and/or priority for this trip.&amp;nbsp;" name="please-describe-the-overall-feel-andor-priority-for-this-trip-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>