Cheri Panzloff

Travel Mon Cheri™ LLC

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    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="First and Last name&lt;br&gt;" name="first-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" 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're not sure  just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Vacation inquiry " name="vacation-inquiry-">&#13;
			<option label="Cruise " value="cruise-">Cruise </option>&#13;
			<option label="All Inclusive Resort " value="all-inclusive-resort-">All Inclusive Resort </option>&#13;
			<option label="River Cruise  " value="river-cruise-">River Cruise  </option>&#13;
			<option label="Expedition Vacation (cruise or land)" value="expedition-vacation-cruise-or-land">Expedition Vacation (cruise or land)</option>&#13;
			<option label="World Cruise" value="world-cruise">World Cruise</option>&#13;
		</field>&#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" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What airport will you be flying from?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How many total travelers in your personal booking?" name="how-many-total-travelers-in-your-personal-booking">&#13;
			<option label="I need solo rates" value="i-need-solo-rates">I need solo rates</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3 " value="3-">3 </option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="This is a group / family vacation - I am the group coordinator" value="this-is-a-group-family-vacation-i-am-the-group-coordinator">This is a group / family vacation - I am the group coordinator</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your PER TRAVELER ALLOWANCE INCLUDING AIRFARE ?" description="This just gives me a general starting point and can always be changed later." inline="true" name="budget" other="true">&#13;
			<option label="$1500.00- to $3500.00 pp" value="150000-to-350000-pp">$1500.00- to $3500.00 pp</option>&#13;
			<option label="$3501.00 to $4500.00 pp" value="350100-to-450000-pp">$3501.00 to $4500.00 pp</option>&#13;
			<option label="$4501.00 to $6500.00 pp" value="450100-to-650000-pp">$4501.00 to $6500.00 pp</option>&#13;
			<option label="$6500.00 to $8500.00 pp" value="650000-to-850000-pp">$6500.00 to $8500.00 pp</option>&#13;
			<option label="$8600.00 +" value="860000-">$8600.00 +</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference">&#13;
			<option label="Moderate " value="moderate-">Moderate </option>&#13;
			<option label="All Inclusive" value="all-inclusive">All Inclusive</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Vacation Prefrences" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Foodie" value="foodie">Foodie</option>&#13;
			<option label="Gambling " value="gambling-">Gambling </option>&#13;
			<option label="Scuba / Snorkel" value="scuba-snorkel">Scuba / Snorkel</option>&#13;
			<option label="Adventure activities- Hiking, Mountan Climbing, Off the Beaten Path" value="adventure-activities-hiking-mountan-climbing-off-the-beaten-path">Adventure activities- Hiking, Mountan Climbing, Off the Beaten Path</option>&#13;
			<option label="Luxury Golf Course included" value="luxury-golf-course-included">Luxury Golf Course included</option>&#13;
			<option label="Nightlife / Party " value="nightlife-party-">Nightlife / Party </option>&#13;
			<option label="Arts Deco / Theater / City Stays" value="arts-deco-theater-city-stays">Arts Deco / Theater / City Stays</option>&#13;
			<option label="Concierge Class Cruising - Luxury Service" value="concierge-class-cruising-luxury-service">Concierge Class Cruising - Luxury Service</option>&#13;
			<option label="Ocean Cruise - [" value="ocean-cruise-">Ocean Cruise - [</option>&#13;
			<option label="River Cruise " value="river-cruise-">River Cruise </option>&#13;
			<option label="Expedition Cruise - Penguins / Galapagos/ Antartica " value="expedition-cruise-penguins-galapagos-antartica-">Expedition Cruise - Penguins / Galapagos/ Antartica </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What is your booking time-frame?" name="what-is-your-booking-timeframe">&#13;
			<option label="I am deposit ready- I want the best prices and availability" value="i-am-deposit-ready-i-want-the-best-prices-and-availability">I am deposit ready- I want the best prices and availability</option>&#13;
			<option label="I am just starting to look, but ready to deposit within a week" value="i-am-just-starting-to-look-but-ready-to-deposit-within-a-week">I am just starting to look, but ready to deposit within a week</option>&#13;
			<option label="2 weeks or more, I understand that I may not get the best price or available room if I wait" value="2-weeks-or-more-i-understand-that-i-may-not-get-the-best-price-or-available-room-if-i-wait">2 weeks or more, I understand that I may not get the best price or available room if I wait</option>&#13;
			<option label="I already booked part of it myself but want some help with my trip" value="i-already-booked-part-of-it-myself-but-want-some-help-with-my-trip">I already booked part of it myself but want some help with my trip</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
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