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<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="&amp;nbsp;VACATION INTAKE&amp;nbsp; FORM"/>&#13;
		<field type="date" required="true" label="TODAY&#39;S DATE" name="todays-date" className="form-control"/>&#13;
		<field type="text" required="true" label="FIRST NAME" name="first-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="EMAIL" placeholder="EXAMPLE@EXAMPLE.COM" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="PHONE NUMBER" placeholder="000-000-0000" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="AGENT" name="agent">&#13;
			<option label="AFRIKA " value="afrika-">AFRIKA </option>&#13;
			<option label="COCO" value="coco">COCO</option>&#13;
			<option label="NIA" value="nia">NIA</option>&#13;
			<option label="NO PREFERENCE" value="no-preference">NO PREFERENCE</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="DESTINATION" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="WHAT IS YOUR DEPARTURE CITY?" description="Where will you be flying from?" placeholder="Flying From" name="departure-city" subtype="text" 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="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="checkbox-group" required="true" label="ARE YOUR DATES FLEXIBLE?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="NUMBER OF TRAVELERS" description="HOW MANY TRAVELERS SHOULD BE INCLUIDED IN YOUR QUOTE?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="PACKAGE TYPE:" name="package-type">&#13;
			<option label="FLIGHT ONLY" value="flight-only">FLIGHT ONLY</option>&#13;
			<option label="HOTEL ONLY" value="hotel-only">HOTEL ONLY</option>&#13;
			<option label="FLIGHT + HOTEL" value="flight-hotel">FLIGHT + HOTEL</option>&#13;
			<option label="FLIGHT + HOTEL + ACTIVITIES" value="flight-hotel-activities">FLIGHT + HOTEL + ACTIVITIES</option>&#13;
			<option label="FLIGHT + HOTEL + ACTIVITIES + ROUNDTRIP TRANSFERS (RECOMMENDED)" value="flight-hotel-activities-roundtrip-transfers-recommended">FLIGHT + HOTEL + ACTIVITIES + ROUNDTRIP TRANSFERS (RECOMMENDED)</option>&#13;
			<option label="FLIGHT + HOTEL + ROUNDTRIP TRANSFERS" value="flight-hotel-roundtrip-transfers">FLIGHT + HOTEL + ROUNDTRIP TRANSFERS</option>&#13;
			<option label="CRUISE ONLY" value="cruise-only">CRUISE ONLY</option>&#13;
			<option label="CRUISE + FLIGHT" value="cruise-flight">CRUISE + FLIGHT</option>&#13;
			<option label="CRUISE + FLIGHT + ROUNDTRIP TRANSFERS" value="cruise-flight-roundtrip-transfers">CRUISE + FLIGHT + ROUNDTRIP TRANSFERS</option>&#13;
			<option label="OTHER" value="other">OTHER</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="RESORT PREFERENCE" name="resort-preference">&#13;
			<option label="FAMILY STYLE" value="family-style">FAMILY STYLE</option>&#13;
			<option label="ADULTS ONLY" value="adults-only">ADULTS ONLY</option>&#13;
			<option label="NO PREFERENCE" value="no-preference">NO PREFERENCE</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="ALL INCLUSIVE" name="all-inclusive">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="WHAT IS YOUR BUDGET FOR EACH TRAVELER (PER PERSON)" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,000 to $2,000" value="1000-to-2000">$1,000 to $2,000</option>&#13;
			<option label="$2,001 to $3,000" value="2001-to-3000">$2,001 to $3,000</option>&#13;
			<option label="$3001 to $4,000" value="3001-to-4000">$3001 to $4,000</option>&#13;
			<option label="$4,001 to $5,000" value="4001-to-5000">$4,001 to $5,000</option>&#13;
			<option label="$5,001 to $6,000" value="5001-to-6000">$5,001 to $6,000</option>&#13;
			<option label="$6,000+" value="6000">$6,000+</option>&#13;
			<option label="OTHER" value="other">OTHER</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="PERFERRED AIRLINE" name="perferred-airport">&#13;
			<option label="DELTA" value="delta">DELTA</option>&#13;
			<option label="UNITED" value="united">UNITED</option>&#13;
			<option label="JETBLUE" value="jetblue">JETBLUE</option>&#13;
			<option label="AMERICAN AIRLINES" value="american-airlines">AMERICAN AIRLINES</option>&#13;
			<option label="SOUTHWEST" value="southwest">SOUTHWEST</option>&#13;
			<option label="OTHER" value="other">OTHER</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="text" label="OTHER (AIRLINE)" name="other-airline" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="CAR RENTAL" name="car-rental">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="TRAVEL PROTECTION?" description="Should Travel Protection be included in your quote" name="travel-protection">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like us to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" placeholder="IF CRUISING, PLEASE LIST COMPANY PREFERENCE HERE." name="notes" className="form-control"/>&#13;
		<field type="textarea" required="true" label="HOW DID YOU HEAR ABOUT US?" placeholder="Who should we thank for sending you our way?" name="how-did-you-hear-about-us" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>