Share your information with Rechelyn Dionco-Orias

Rechelyn Dionco-Orias

Roman Ortiz Travel Partners

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h1" label="Vacation Planning Inquiry Form"/>&#13;
		<field type="paragraph" subtype="p" label="Tell us about your trip! This short form helps us create a personalized vacation proposal with the best resorts, flights, and activities for you. It only takes 2 minutes to complete!"/>&#13;
		<field type="header" subtype="h2" label="Lead Traveler Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="Phone number" placeholder="xxx-xxx-xxxx" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" placeholder="ex: Arlington" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" placeholder="ex: Texas" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" placeholder="ex: United States" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Information"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" description="We will give you what you request. But we will also search for the best dates  and best rates." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" toggle="true" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" 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" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Is there any kids?" toggle="true" name="checkbox-group-1759174063768">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="If &quot;yes&quot;, how many?" name="text-1759174190373" subtype="text" className="form-control"/>&#13;
		<field type="select" label="What is your budget for your vacation?" description="This just gives me a general starting point and can always be changed later." name="what-is-your-budget-for-your-vacation" className="form-control">&#13;
			<option label="Select your ideal budget" value="select-your-ideal-budget">Select your ideal budget</option>&#13;
			<option label="$1,500 to $2,500" value="1500-to-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-to-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-to-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How did you hear from us?" description="Check all that apply" name="how-did-you-hear-from-us" other="true">&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Google Search" value="google-search">Google Search</option>&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>