<html> <body> <form-template> <fields> <field label="The Original Platinum Travels Trip Request" subtype="h1" type="header"/> <field label="Thank you for your request to book an amazing trip with Original Platinum Travels, Co! We are excited to begin the process of creating your amazing travel experiences. Please fill out this form as detailed as possible. Once received we will reach out to set up a time to discuss your trip needs and desire. Starting January 2023, Research Fees will be required in order to move forward with your request.&nbsp; Individual Trips of 5 or fewer guests require a $50 Deposit and groups 6 to 15 require $100. For anything over 16 passengers, we will discuss deposits based on group needs and dynamics. Please see the Terms and Conditions at the bottom." subtype="p" type="paragraph"/> <field label="Full name" subtype="h2" type="header"/> <field label="Prefix" name="prefix" subtype="text" type="text" className="form-control"/> <field label="First name" name="first-name" required="true" subtype="text" type="text" className="form-control"/> <field label="Middle name" name="middle-name" subtype="text" type="text" className="form-control"/> <field label="Last name" name="last-name" required="true" subtype="text" type="text" className="form-control"/> <field label="Suffix" name="suffix" subtype="text" type="text" className="form-control"/> <field label="Preferred name" name="preferred-name" subtype="text" type="text" className="form-control"/> <field label="Address" subtype="h2" type="header"/> <field label="Line 1" name="address-line-1" subtype="text" type="text" className="form-control"/> <field label="Line 2" name="address-line-2" subtype="text" type="text" className="form-control"/> <field label="City" name="address-city" required="true" subtype="text" type="text" className="form-control"/> <field label="State" name="address-state" required="true" subtype="text" type="text" className="form-control"/> <field label="Zip" name="address-zip" subtype="text" type="text" className="form-control"/> <field label="Country" name="address-country" required="true" subtype="text" type="text" className="form-control"/> <field label="Email" name="email" required="true" subtype="text" type="text" className="form-control"/> <field label="Phone number" name="phone-number" required="true" subtype="text" type="text" className="form-control"/> <field label="Important Dates" subtype="h2" type="header"/> <field label="Birthday" name="birthday" required="true" type="date" className="form-control"/> <field label="Wedding anniversary" name="wedding-anniversary" type="date" className="form-control"/> <field label="Questions for your trip" subtype="h2" type="header"/> <field description="If you're not sure just give me a few destinations you're considering." label="Where would you like to go?" name="destination" placeholder="ex: Tahiti" required="true" subtype="text" type="text" className="form-control"/> <field description="This just gives me a general idea of when you like to go; it can be changed later." label="When would you like to depart?" name="starting-at" required="true" type="date" className="form-control"/> <field description="This just gives me a general idea of when you like to return; it can be changed later." label="When would you like to return?" name="ending-at" required="true" type="date" className="form-control"/> <field description="Where will you be flying from?" label="What is your Airport Code?" name="departure-city" required="true" subtype="text" type="text" className="form-control"/> <field label="Many countries require you to be vaccinated to enter. Those who are unvaccinated will have to follow increased procedures and may have to face quarantine and multiple tests upon arrival. By knowing your status will help me prepare you for your trip.&nbsp;" subtype="p" type="paragraph"/> <field label="Are you vaccinated?&nbsp;" name="are-you-vaccinated-" required="true" type="select" className="form-control"> <option label="Yes, fully vaccinated " selected="selected" value="yes-fully-vaccinated-">Yes, fully vaccinated </option> <option label="No, but planning to before trip" value="no-but-planning-to-before-trip">No, but planning to before trip</option> <option label="No" value="no">No</option> </field> <field label="Are your dates flexible?" name="dates-flexible" type="checkbox-group"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field label="How many travelers?" name="number-of-travelers" required="true" type="text" className="form-control"/> <field label="If your dates are flexible, what is your flexibility?&nbsp;" name="if-your-dates-are-flexible-what-is-your-flexibility-" subtype="text" type="text" className="form-control"/> <field label="How Many Rooms Do You Need?" name="how-many-rooms-do-you-need" required="true" subtype="text" type="text" className="form-control"/> <field label="Please provide the names and Emails of all Adults traveling. If this is a Solo or Couple Trip, please put N/A" name="please-provide-the-names-and-emails-of-all-adults-traveling-if-this-is-a-solo-or-couple-trip-please-put-na" required="true" rows="5" type="textarea" className="form-control"/> <field label="Are there any Children traveling? If so what are their ages at the time of travel? Please provide DOB and Full Names" name="are-there-any-children-traveling-if-so-what-are-their-ages-at-the-time-of-travel" subtype="text" type="text" className="form-control"/> <field label="Will there be anyone over 55 traveling?" name="will-there-be-anyone-over-55-traveling" subtype="text" type="text" className="form-control"/> <field description="This just gives me a general starting point and can always be changed later." label="What is your budget for each traveler?" name="budget" required="true" type="radio-group"> <option label="$1,500- $2,500" value="1500-2500">$1,500- $2,500</option> <option label="$2,500 to $3,500" value="2500-to-3500">$2,500 to $3,500</option> <option label="$3,500 to $4,500" value="3500-to-4500">$3,500 to $4,500</option> <option label="$5,500 to $6,500" value="5500-to-6500">$5,500 to $6,500</option> <option label="$7,500 to $8,500" value="7500-to-8500">$7,500 to $8,500</option> <option label="$9,000+" value="9000">$9,000+</option> <option label="Unlimited Budget" value="unlimited-budget">Unlimited Budget</option> </field> <field label="Loyalty Programs" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" name="loyalty-program" type="clientLoyaltyPrograms" className="form-control"/> <field label="Travel Preferences" subtype="h2" type="header"/> <field label="Seat preference" name="seat-preference" required="true" type="radio-group"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Opposite aisle" value="opposite aisle">Opposite aisle</option> </field> <field label="Bed preference" name="bed-preference" required="true" type="radio-group"> <option label="King" value="king">King</option> <option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option> </field> <field label="Meal preference -&nbsp; Vegan, Vegetarian, any dietary restrictions&nbsp;" name="meal-preference" required="true" subtype="text" type="text" className="form-control"/> <field label="What best describes your hotel preference?" name="hotel-preference" other="true" required="true" type="radio-group"> <option label="Vacation Homes/Rentals" value="vacation-homesrentals">Vacation Homes/Rentals</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field description="Check all that apply." label="What kind of vibe are you looking for?" name="vibe-preference" other="true" required="true" type="checkbox-group"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</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="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-wine">Food and wine</option> <option label="Adventure" value="adventure">Adventure</option> <option label="LGBTQ" value="lgbtq">LGBTQ</option> </field> <field description="Check all that apply" label="What activities are you interested in?" name="activity-preferences" other="true" required="true" type="checkbox-group"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</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 theater" value="art-theater">Arts and theater</option> </field> <field description="The more information you provide the better the quote will be" label="Anything you absolutely must do or see?" name="must-dos" required="true" subtype="text" type="text" className="form-control"/> <field description="What else would you like me to know about your travelers budget and/or travel preferences?" label="What else would you like me to know?" name="notes" required="true" type="textarea" className="form-control"/> <field label="Additional Contact Info" subtype="h2" type="header"/> <field label="Website" name="website" subtype="text" type="text" className="form-control"/> <field label="Job title" name="job-title" subtype="text" type="text" className="form-control"/> <field label="Company" name="company" subtype="text" type="text" className="form-control"/> <field label="Greek Association" name="greek-association" subtype="text" type="text" className="form-control"/> <field label="Facebook profile" name="facebook-profile" subtype="text" type="text" className="form-control"/> <field label="LinkedIn profile" name="linkedin-profile" subtype="text" type="text" className="form-control"/> <field label="Twitter profile" name="twitter-profile" subtype="text" type="text" className="form-control"/> <field label="Instagram profile" name="instagram-profile" subtype="text" type="text" className="form-control"/> <field label="Passport Info" subtype="h2" type="header"/> <field label="Full name as it appears on passport" name="passport-name" required="true" subtype="text" type="text" className="form-control"/> <field label="Passport number" name="passport-number" subtype="text" type="text" className="form-control"/> <field label="Country of issue" name="passport-country-of-issue" subtype="text" type="text" className="form-control"/> <field label="Date of issue" name="passport-date-of-issue" type="date" className="form-control"/> <field label="Date of expiration" name="passport-date-of-expiration" type="date" className="form-control"/> <field label="Gender has on passport" name="gender" required="true" type="radio-group"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field label="Place of birth" name="place-of-birth" subtype="text" type="text" className="form-control"/> <field label="Nationality" name="nationality" subtype="text" type="text" className="form-control"/> <field label="Citizenship" name="citizenship" subtype="text" type="text" className="form-control"/> </fields> </form-template> </body> </html>
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