<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Travel Questionnaire"/> <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" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" placeholder="Phone number" name="phone-number" 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="Departure City" description="List the preferred airport." placeholder="City or Airport code" name="departure-city" subtype="text" className="form-control"/> <field type="text" required="true" label="Where would you like to travel?" description="For international travel U.S. CITIZENS MUST HAVE A VALID PASSPORT BOOK that is valid for 6 months after the return from their trip." name="where-would-you-like-to-travel" subtype="text" className="form-control"/> <field type="select" required="true" label="What type of experience are you looking for?" placeholder="Select one" name="what-type-of-experience-are-you-looking-for" className="form-control"> <option label="Hotel/Villa" value="hotelvilla">Hotel/Villa</option> <option label="All-Inclusive (Caribbean & Mexico)" value="allinclusive-caribbean-mexico">All-Inclusive (Caribbean & Mexico)</option> <option label="Escorted Tour" value="escorted-tour">Escorted Tour</option> <option label="Cruise" value="cruise">Cruise</option> </field> <field type="header" subtype="h1" label="Cruise Options (If Applicable)"/> <field type="select" label="Cruise Line" placeholder="Select One" name="cruise-line" className="form-control"> <option label="No Preference" value="no-preference">No Preference</option> <option label="Carnival" value="carnival">Carnival</option> <option label="Royal Caribbean" value="royal-caribbean">Royal Caribbean</option> <option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option> <option label="Norwegian" value="norwegian">Norwegian</option> <option label="Princess" value="princess">Princess</option> <option label="MSC" value="msc">MSC</option> <option label="Disney" value="disney">Disney</option> <option label="Other" value="other">Other</option> </field> <field type="radio-group" label="Cabin Category" inline="true" name="cabin-category"> <option label="Interior" value="interior">Interior</option> <option label="Ocean View" value="ocean-view">Ocean View</option> <option label="Balcony" value="balcony">Balcony</option> <option label="Suite" value="suite">Suite</option> </field> <field type="radio-group" label="Cabin Location" description="In what part of the ship do you prefer your stateroom?" inline="true" name="cabin-location"> <option label="Aft (Rear)" value="aft-rear">Aft (Rear)</option> <option label="Middle" value="middle">Middle</option> <option label="Forward (Front)" value="forward-front">Forward (Front)</option> <option label="No Preference" value="no-preference">No Preference</option> </field> <field type="checkbox-group" label="Cruise Amenities" inline="true" name="cruise-amenities"> <option label="Drink Package" value="drink-package">Drink Package</option> <option label="WiFi Package" value="wifi-package">WiFi Package</option> <option label="Specialty Dining" value="specialty-dining">Specialty Dining</option> <option label="Spa Services" value="spa-services">Spa Services</option> </field> <field type="header" subtype="h1" label="Travel Info"/> <field type="radio-group" required="true" label="Are you in need of a flight?" inline="true" name="are-you-in-need-of-a-flight"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="select" required="true" label="Sleeping Accommodations" description="When requesting two beds the size will be determined by what is provided by the hotel/resort." placeholder="Beds per room" name="sleeping-accommodations" className="form-control"> <option label="1 King" value="1-king">1 King</option> <option label="2 Twins/Doubles/Queens" value="2-twinsdoublesqueens">2 Twins/Doubles/Queens</option> <option label="Other" value="other">Other</option> </field> <field type="date" required="true" label="When would you like to depart?" description="If exact date isn't known provide a date within your available timeframe. This can be changed later." name="when-would-you-like-to-depart" className="form-control"/> <field type="date" required="true" label="When would you like to return?" description="If exact date isn't known provide a date within your available timeframe. This can be changed later." name="when-would-you-like-to-return" className="form-control"/> <field type="text" required="true" label="How many adults will be on this trip?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="select" label="How many children ages 17 &amp; below?" description="List the age they'll be at the time of travel." placeholder="Select One" name="how-many-children-ages-17-below" multiple="multiple" className="form-control"> <option label="0" value="0">0</option> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> <option label="4" value="4">4</option> <option label="5" value="5">5</option> <option label="6" value="6">6</option> <option label="7" value="7">7</option> <option label="8" value="8">8</option> <option label="9" value="9">9</option> <option label="10" value="10">10</option> <option label="11" value="11">11</option> <option label="12" value="12">12</option> <option label="13" value="13">13</option> <option label="14" value="14">14</option> <option label="15+" value="15">15+</option> </field> <field type="paragraph" subtype="p" label="Your trip is a significant investment, and we recommend the purchase of travel insurance. If you choose to decline this valuable protection, you are assuming any financial loss associated with your travel arrangements. By declining to purchase travel insurance you fully understand that your travel agent is not liable or responsible for any expenses incurred as a result of cancellation or interruption, emergency medical and transportation, baggage and personal effects, flight and travel accident, and/ or rental car physical damage."/> <field type="radio-group" required="true" label="Do you wish to purchase Travel Insurance? (strongly recommended)" name="do-you-wish-to-purchase-travel-insurance-strongly-recommended"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="I am not sure. Please discuss my options." value="i-am-not-sure-please-discuss-my-options">I am not sure. Please discuss my options.</option> </field> <field type="radio-group" required="true" label="Will Ground Transfer be needed?" description="Round-trip shuttle to/from the airport." inline="true" name="will-a-ground-transfer-be-needed"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="radio-group" label="Seat preference" inline="true" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> </field> <field type="text" label="Meal preference" placeholder="Any dietary restrictions?" name="meal-preference" subtype="text" className="form-control"/> <field type="checkbox-group" label="Vibe preferences" inline="true" name="vibe-preference"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and Relaxation" value="rest-and-relaxation">Rest and Relaxation</option> <option label="Party" value="party">Party</option> <option label="Local Culture" value="local-culture">Local Culture</option> <option label="Family Friendly" value="family-friendly">Family Friendly</option> <option label="Food and Wine" value="food-and-wine">Food and Wine</option> <option label="LGBTQ" value="lgbtq">LGBTQ</option> </field> <field type="checkbox-group" label="Activity preferences" inline="true" name="activity-preferences"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Scuba/Snorkel" value="scubasnorkel">Scuba/Snorkel</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theatre" value="art-theatre">Arts and theatre</option> <option label="Museums and Architecture" value="museums-and-architecture">Museums and Architecture</option> </field> <field type="select" label="Are you celebrating a special occasion? If so, what?" placeholder="Select if applicable" name="are-you-celebrating-a-special-occasion-if-so-what" className="form-control"> <option label="Birthday" value="birthday">Birthday</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Graduation" value="graduation">Graduation</option> </field> <field type="text" required="true" label="What is your desired budget?" placeholder="Enter budget amount" name="what-is-your-desired-budget" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Budget Type?" inline="true" name="budget-type"> <option label="Per Person" value="per-person">Per Person</option> <option label="Total" value="total">Total</option> </field> <field type="text" label="How did you hear of Perfected Travel?" name="how-did-you-hear-of-perfected-travel" subtype="text" className="form-control"/> <field type="textarea" label="Any medical concerns, handicaps, or special needs?" placeholder="List all that are applicable" name="any-medical-concerns-handicaps-or-special-needs" rows="3" className="form-control"/> <field type="textarea" label="Additional Info" placeholder="Anything to add?" name="additional-info" rows="3" className="form-control"/> <field type="header" subtype="h1" label="Terms &amp; Conditions"/> <field type="paragraph" subtype="p" label="Cancellations requested are subject to a $50 cancellation fee per booking paid to Perfected Travel. This fee must be paid before the cancellation can be processed. For packages booked through Southwest Vacations, the air portion of the vacation package is non-refundable but can be redeemed by the same passenger for future travel. The entire air portion must be paid in order to receive the credit. For other vacation packages, a minimum cancellation penalty of $50 per person plus applicable hotel and airline penalties will be charged by the supplier in addition to Perfected Travel's cancellation fee, unless Travel Insurance was purchased."/> <field type="paragraph" subtype="p" label="&nbsp;"/> <field type="paragraph" subtype="p" label="Final payments must be paid by the Final Due Date to avoid automatic cancellation by the supplier. If a reservation is automatically canceled due to lack of final payment, no monies will be refunded."/> <field type="paragraph" subtype="p" label="&nbsp;"/> <field type="paragraph" subtype="p" label="Changes made to your reservation once booked, will incur a $25 administration fee per occurrence by Perfected Travel, in addition to possible fees charged by the supplier. These include, but are not limited to: correction to personal information, changing hotel and/or flight accommodations, and changing the number of passengers (which may increase the per person amount for the remaining passengers)."/> </fields> </form-template> </body> </html>
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