Share your information with Beth Simms

Beth Simms

The Hello Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Trip Inquiry Form"/>&#13;
		<field type="header" subtype="h1" label="Client Information"/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="About Your Trip"/>&#13;
		<field type="checkbox-group" required="true" label="I am most interested in speaking with you about planning for the following:" name="i-am-most-interested-in-speaking-with-a-travel-advisor-about-the-following">&#13;
			<option label="Africa" value="africa">Africa</option>&#13;
			<option label="Alaska/Canada" value="alaskacanada">Alaska/Canada</option>&#13;
			<option label="All-Inclusive Resort Vacations" value="allinclusive-resort-vacations">All-Inclusive Resort Vacations</option>&#13;
			<option label="Asia" value="asia">Asia</option>&#13;
			<option label="Central America (Costa Rica, Belize, Etc.)" value="central-america-costa-rica-belize-etc">Central America (Costa Rica, Belize, Etc.)</option>&#13;
			<option label="Customized European Vacations" value="customized-european-vacations">Customized European Vacations</option>&#13;
			<option label="Escorted Group Tours" value="escorted-group-tours">Escorted Group Tours</option>&#13;
			<option label="European Ocean Cruising" value="european-ocean-cruising">European Ocean Cruising</option>&#13;
			<option label="European River Cruising" value="european-river-cruising">European River Cruising</option>&#13;
			<option label="Hawaii" value="hawaii">Hawaii</option>&#13;
			<option label="Luxury Hotel-Only" value="luxury-hotelonly">Luxury Hotel-Only</option>&#13;
			<option label="Ocean Cruising " value="ocean-cruising-">Ocean Cruising </option>&#13;
			<option label="Ski Vacations" value="ski-vacations">Ski Vacations</option>&#13;
			<option label="Something Else* (see below)" value="something-else-see-below">Something Else* (see below)</option>&#13;
		</field>&#13;
		<field type="textarea" label="If you selected &quot;Something Else&quot;, please explain what you are interested in." name="if-you-selected-something-else-please-explain-what-you-are-interested-in" rows="4" className="form-control"/>&#13;
		<field type="text" required="true" label="What are your estimated travel dates?" name="what-are-your-estimated-travel-dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="If needed, I am open to working with another agent on the team." name="checkbox-group-1772825316476">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="**Next Steps - Please be on the lookout for an email from me to continue our Planning Process**"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>