<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Airfare - Head of Household"/> <field type="text" label="Text Field" name="text-1645300104809" value="Before we can book your flights we need to collect a little bit of information from you. For your safety airlines and international security are quite strict about documentation. If your passport does not match your ticket perfectly it could be a showstopper at the airport. We ask you to double-check the details you enter below. It’s all about ensuring your journey is as seamless as your dreams! This information will be stored on a PCI compliant website. Thank you!" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Passport Information"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <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="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of birth" name="birthday" className="form-control"/> <field type="radio-group" required="true" label="Gender" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field type="text" label="Passport number (this may be required for some bookings by the supplier/airline)" name="passport-number" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of issue" name="passport-date-of-issue" className="form-control"/> <field type="date" required="true" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="text" required="true" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/> <field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/> <field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/> <field type="text" label="Do you have a Permanent Resident Card /Green Card?&nbsp; &nbsp;If yes, when does it expire?" name="text-1710531783268" subtype="text" className="form-control"/> <field type="paragraph" subtype="p" label="On June 1, 2019, as part of IATA Resolution 830d, the International Air Transport Association (IATA) began to require that all travel advisors and travel agencies enter passenger contact information when booking air tickets in order to help contact the passenger “in an operational disruption” and so that airlines are “able to advise passengers of irregular flight operations and disruptions.” "/> <field type="paragraph" subtype="p" label="For this reason, the information you provide on this form will be stored on a PCI-compliant website. Be assured that the information will never be sold or shared with anyone for any other purpose than to book your travel arrangements."/> <field type="checkbox-group" required="true" label="By checking off this box, I am confirming that I have read and understand IATA's new regulations regarding disclosing my contact information to the airline/s" name="by-checking-off-this-box-i-am-confirming-that-i-have-read-and-understand-iatas-new-regulations-regarding-disclosing-my-contact-information-to-the-airlines"> <option label="I allow for Perfectly Planned Journeys to collect my contact information and pass it on to the airline/s." value="i-allow-for-perfectly-planned-journeys-to-collect-my-contact-information-and-pass-it-on-to-the-airlines">I allow for Perfectly Planned Journeys to collect my contact information and pass it on to the airline/s.</option> <option label="I decline to provide my contact information, and understand that this will prevent the airline/s from contacting me with pertinent information." value="i-decline-to-provide-my-contact-information-and-understand-that-this-will-prevent-the-airlines-from-contacting-me-with-pertinent-information">I decline to provide my contact information, and understand that this will prevent the airline/s from contacting me with pertinent information.</option> </field> <field type="header" subtype="h1" label="Contact Information"/> <field type="text" required="true" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/> <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" name="address-country" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Travel Request"/> <field type="radio-group" required="true" label="What type of ticket will you need?" name="what-type-of-ticket-will-you-need"> <option label="One Way" value="one-way">One Way</option> <option label="Round Trip" value="round-trip">Round Trip</option> <option label="Multi Destination" value="multi-destination">Multi Destination</option> </field> <field type="text" required="true" label="How many people will you be traveling with?&nbsp; (including those not in your household)" name="how-many-people-will-you-be-traveling-with" subtype="text" className="form-control"/> <field type="text" label="How many adults from your household in addition to you are traveling?" name="how-many-of-the-travelers-live-in-your-household-in-addition-to-you" subtype="text" className="form-control"/> <field type="text" label="How many children (age 2 - 11 years old) from your household will be traveling?" name="how-many-children-age-2-11-years-old-from-your-household-will-be-traveling" subtype="text" className="form-control"/> <field type="text" label="How many infants from your household will be traveling?" name="how-many-infants-from-your-household-will-be-traveling" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of Departure" name="preferred-date-of-departure" className="form-control"/> <field type="text" label="Is your departure date&nbsp; flexible?&nbsp; Please give alternate dates." name="please-specify-below-if-your-dates-are-flexible" subtype="text" className="form-control"/> <field type="text" required="true" label="Preferred Departure Airport&nbsp;&nbsp;" name="preferred-departure-airport-" subtype="text" className="form-control"/> <field type="text" label="Is there an alternate airport you would be willing to depart from if the price or flight schedule is significantly better?&nbsp; Please list airport/s." name="alternate-airports" subtype="text" className="form-control"/> <field type="text" label="Flying to:&nbsp; (please specify all destinations &amp; dates)" name="flying-to-please-specify-all-destinations-dates" subtype="text" className="form-control"/> <field type="date" label="Date of Return&nbsp; (the date you leave the destination)" name="preferred-date-of-return-the-date-you-leave-the-destination" className="form-control"/> <field type="header" subtype="h1" label="Travel Preferences"/> <field type="paragraph" subtype="p" label="We will do our best to accommodate your preferences but please understand that this is not always possible.&nbsp; &nbsp; &nbsp; Basic Economy tickets do not allow seat selection.&nbsp;&nbsp;"/> <field type="radio-group" label="Seat preference" description="Please note that we are not always able to get your first choice of seats and the airline may switch your seat after it has been assigned" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Least Expensive" value="least-expensive">Least Expensive</option> </field> <field type="textarea" label="Frequent Flyer Accounts.&nbsp; Please include your acct. # if you would like to enter it for you." name="frequent-flyer-accounts-please-include-your-acct-if-you-would-like-to-enter-it-for-you" className="form-control"/> <field type="radio-group" label="Fare Type" name="fare-type"> <option label="First Class" value="first-class">First Class</option> <option label="Business" value="business">Business</option> <option label="Premium Economy" value="premium-economy">Premium Economy</option> <option label="Economy Plus" value="economy-plus">Economy Plus</option> <option label="Economy" value="economy">Economy</option> <option label="Basic Economy" value="basic-economy">Basic Economy</option> <option label="Checked Luggage" value="checked-luggage">Checked Luggage</option> <option label="Select Seat - (for a price)" value="select-seat-for-a-price">Select Seat - (for a price)</option> <option label="Carbon Offset (optional)" value="carbon-offset-optional">Carbon Offset (optional)</option> </field> <field type="text" label="This could be for instance that you will take the best fare class you can get within a certain budget, or&nbsp; maybe you want Business Class for only part of the trip etc." name="this-could-be-for-instance-that-you-will-take-the-best-fare-class-you-can-get-within-a-certain-budget-or-maybe-you-want-business-class-for-only-part-of-the-trip-etc" subtype="text" className="form-control"/> <field type="text" label="Max amount you are willing to pay?&nbsp; You may wonder why I would ask this.&nbsp; &nbsp;The reason is that you may request Premium Economy, but for a&nbsp; little bit more you could have Business, and be much more comfortable.&nbsp; Esp. if it is a very long flight this may be a great option.&nbsp; &nbsp;Since I can not hold two tickets for you these seats ma be gone if I have to check with your first." name="max-amount-you-are-willing-to-pay-you-may-wonder-why-i-would-ask-this-the-reason-is-that-you-may-request-premium-economy-but-for-a-little-bit-more-you-could-have-business-and-be-much-more-comfortable-esp-if-it-is-a-very-long-flight-this-may-be-a-great-option-since-i-can-not-hold-two-tickets-for-you-these-seats-ma-be-gone-if-i-have-to-check-with-your-first" subtype="text" className="form-control"/> <field type="radio-group" label="Special Requests" name="special-requests"> <option label="Need Assistance / Wheelchair etc." value="need-assistance-wheelchair-etc">Need Assistance / Wheelchair etc.</option> <option label="Traveling w/Big/Unusual Size Luggage" value="traveling-wbigunusual-size-luggage">Traveling w/Big/Unusual Size Luggage</option> <option label="Extra Luggage" value="extra-luggage">Extra Luggage</option> <option label="Medication * / Special Medical Equipment" value="medication-special-medical-equipment">Medication * / Special Medical Equipment</option> <option label="Animal" value="animal">Animal</option> </field> <field type="textarea" label="Text Area" name="textarea-1710611914367" value="This does not refer to common medication that does not need any special care. We are referring to medications that have unusual requirements. (needs to be kept cold at all times for instance)" className="form-control"/> <field type="header" subtype="h1" label="Additional Info"/> <field type="text" label="Is there any additional&nbsp;information&nbsp; we should know?" name="additional-info-about-your-needs-and-hopes-for-your-trip-that-you-believe-is-important-for-successful-planning" subtype="text" className="form-control"/> <field type="radio-group" label="Would you like a quote for travel insurance?" name="would-you-like-a-quote-for-travel-insurance"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h1" label="How did you hear about us"/> <field type="text" label="Please tell us how you heard about us." name="please-tell-us-how-you-heard-about-us" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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