<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Custom Vacation Form"/> <field type="paragraph" subtype="p" label="Are you looking for a custom vacation?&nbsp; &nbsp;It can be in the anywhere around the world.&nbsp; &nbsp;Get started here by completing this form.&nbsp; &nbsp;You dream it we plan it!"/> <field type="header" subtype="h2" label="Full name"/> <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="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="radio-group" label="Gender" name="gender"> <option label="M" value="m">M</option> <option label="F" value="f">F</option> <option label="X" value="x">X</option> </field> <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"/> <field type="textarea" label="Additional Travelers: Legal Names &amp; Ages *If kids are traveling. please indicate here the ages and how many kids will be traveling.&nbsp;&nbsp;" description="If travel is booked with GXT Travel each additional traveler will need to fill out their own profile form" name="additional-travelers-legal-names-ages-if-travel-is-booked-with-gxt-travel-each-additional-traveler-will-need-to-fill-out-their-own-profile-form" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" required="true" label="Country" description="Quotes are only provided to US residents" name="address-country" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" description="Please provide a valid email address." name="email" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Preferred method of contact" inline="true" name="preferred-method-of-contact"> <option label="Email" value="email">Email</option> <option label="Phone" value="phone">Phone</option> <option label="Text" value="text">Text</option> </field> <field type="text" required="true" label="Destination?" description="If not sure please give at least 3 destinations you would consider." name="destination" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Vacation Type?" inline="true" name="vacation-type" other="true"> <option label="Land Trip: Self Guided" value="land-trip-self-guided">Land Trip: Self Guided</option> <option label="Land Trip: Guided Tour" value="land-trip-guided-tour">Land Trip: Guided Tour</option> <option label="Other" value="other">Other</option> </field> <field type="textarea" required="true" label="Please describe Other vacation type" name="please-describe-other-vacation-type" className="form-control"/> <field type="date" required="true" label="When would you like to depart?" description="Just give general dates if not sure. You can change it at a later time." name="when-would-you-like-to-depart" className="form-control"/> <field type="date" required="true" label="When would you like to return?" description="Just give general dates if not sure. You can change it at a later time." name="when-would-you-like-to-return" className="form-control"/> <field type="radio-group" required="true" label="Are your dates flexible?" inline="true" name="are-your-dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" label="Please list alternate dates, if flexible." name="please-list-alternate-dates-if-flexible" className="form-control"/> <field type="checkbox-group" required="true" label="I would like my quote to include:" inline="true" name="i-would-like-my-quote-to-include" other="true"> <option label="Hotel(s) or Resort(s)" value="hotels-or-resorts">Hotel(s) or Resort(s)</option> <option label="Transportation to the accommodations" value="transportation-to-the-accommodations">Transportation to the accommodations</option> <option label="Airfare" value="airfare">Airfare</option> <option label="Rental Car" value="rental-car">Rental Car</option> <option label="Excursions, Amusement Park Tickets, Activities" value="excursions-amusement-park-tickets-activities">Excursions, Amusement Park Tickets, Activities</option> <option label="Others" value="others">Others</option> </field> <field type="textarea" required="true" label="Please describe any accommodations needed for your trip" description="Please be as specific as possible." name="please-describe-any-accommodations-needed-for-your-trip" className="form-control"/> <field type="text" required="true" label="What is your departure Airport?" description="Where will you be flying from?" name="what-is-your-departure-airport" subtype="text" className="form-control"/> <field type="text" required="true" label="What is your estimated TOTAL budget for per traveler?" name="what-is-your-estimated-total-budget-for-per-traveler" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What best describes your hotel preference?" name="what-best-describes-your-hotel-preference" other="true"> <option label="Economy: I need a clean place to sleep" value="economy-i-need-a-clean-place-to-sleep">Economy: I need a clean place to sleep</option> <option label="Moderate: I prefer a bit more comfort and features" value="moderate-i-prefer-a-bit-more-comfort-and-features">Moderate: I prefer a bit more comfort and features</option> <option label="Luxury: I prefer larger rooms, finer linens, and high level of service" value="luxury-i-prefer-larger-rooms-finer-linens-and-high-level-of-service">Luxury: I prefer larger rooms, finer linens, and high level of service</option> <option label="Boutique: I prefer smaller more intimate local hotels" value="boutique-i-prefer-smaller-more-intimate-local-hotels">Boutique: I prefer smaller more intimate local hotels</option> <option label="Other" value="other">Other</option> </field> <field type="checkbox-group" required="true" label="What kind of vibe are you looking for?" description="Check all that apply." name="what-kind-of-vibe-are-you-looking-for" other="true"> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Adult Only" value="adult-only">Adult Only</option> <option label="Romantic" value="romantic">Romantic</option> <option label="Relaxing" value="relaxing">Relaxing</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Adventurous" value="adventurous">Adventurous</option> <option label="Other" value="other">Other</option> </field> <field type="radio-group" required="true" label="Are celebrating a special occasion?" inline="true" name="are-celebrating-a-special-occasion"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="N/A" value="na">N/A</option> </field> <field type="text" label="Please elaborate here if there is a special occasion being celebrated." name="please-elaborate-here-if-there-is-a-special-occasion-being-celebrated" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Passport Info"/> <field type="radio-group" required="true" label="Do you have a valid passport?" description="Please check that your passport does not expire within 6 months after your return." name="do-you-have-a-valid-passport"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/> <field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/> <field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/> <field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/> <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/> <field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/> <field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/> <field type="textarea" required="true" label="If interested in excursions, please note that in this section." name="if-interested-in-excursions-please-note-that-in-this-section" className="form-control"/> <field type="text" label="Anything you absolutely must do or see?" name="anything-you-absolutely-must-do-or-see" subtype="text" className="form-control"/> <field type="textarea" required="true" label="What else would you like me to know?" description="Please let me know what else you would like for me to know." name="what-else-would-you-like-me-to-know" className="form-control"/> <field type="text" required="true" label="How did you hear about GXT Travel?" description="If you were referred please leave the person that referred you in this section." name="how-did-you-hear-about-gxt-travel" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Terms &amp; Conditions"/> <field type="paragraph" subtype="p" label="The research fees will cover 3 options, 1 destination, for travel. If you are not satisfied, you are entitled to 1 additional option. If not satisfied after that, then an additional research fee will be need for more options. You will receive 3 options each time of quote."/> <field type="paragraph" subtype="p" label="I authorize that I have submitted my research fee to GXT Travel as indicated on this invoice for the noted amount on today's date. This payment is for the services described on the invoice. I understand that all research fee payments made to GXT Travel are non-refundable. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated on this invoice. I also understand that research for my trip will not begin until I have submitted the research fee and the travel quote form. This is a non-refundable fee and does not apply to deposit and trip payment, even if you cancel your trip. It is non-refundable."/> <field type="header" subtype="h1" label="The price for the research fees is as following:"/> <field type="paragraph" subtype="p" label="The fees are due prior to research beginning. This is a flat fee structure. Established Clients: If you are a repeat client that has booked and traveled with GXT Travel, $20 off research fees&nbsp; &nbsp;Once the form and fee are received, please allow up to 48 hours for turnaround for the quote.&nbsp;"/> <field type="header" subtype="h1" label="Fee Breakdown For Quotes:&nbsp;"/> <field type="paragraph" subtype="p" label="1-5 People for 1-2 Destinations: $50"/> <field type="paragraph" subtype="p" label="3 or More Destinations : $65"/> <field type="paragraph" subtype="p" label="Groups of 11 or more people or 3 pr more rooms: $95"/> <field type="paragraph" subtype="p" label="Flights/Hotel/Rental Cars (ala carte services): $35"/> <field type="paragraph" subtype="p" label="Airport Parking Only: $15"/> <field type="paragraph" subtype="p" label="You will be provided with 3 options to choose from on your quote. Should you not find any of those options suitable to your liking, you will be entitled to 1 additional option. If at that time you still do not like those options and the 30 days have passed, you will have to pay another research fee. In the event that you do book a quote and at a later time something should need to be changed, there will be a change fee of $150 due immediately before the change occurs. If you should need to cancel you trip for any reason, if you do not take travel insurance, your monies applied may not be refunded and if a refund is due, it is subject to the suppliers cancelation policy. If you choose not to get travel insurance, a waiver will be signed and will be kept on file to show that you waived travel insurance. You will also agree by signing this form, that you will not do any chargebacks with your bank for this trip. "/> <field type="header" subtype="h1" label="Travel insurance will be added to the vacation package. If you choose to waive the insurance, a waiver is needed to be signed waiving the travel insurance."/> </fields> </form-template> </body> </html>
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