Share your information with Sherell Rutland

Sherell Rutland

Stamped By Sherell

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" required="true" label="Prefix" name="prefix" subtype="text" 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" label="Suffix" name="suffix" 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="date" label="Departure date?" 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="date" label="Return Date" 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="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="Tell us where would you like to go? Not sure don&#39;t worry , answer some additional questions below so we can help you choose." name="tell-us-where-would-you-like-to-go-not-sure-dont-worry-answer-some-additional-questions-below-so-we-can-help-you-choose" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Are you interested in Domestic or Internatioanl Travel?" name="are-you-interested-in-domestic-or-internatioanl-travel" className="form-control">&#13;
			<option label="Domestic" value="domestic">Domestic</option>&#13;
			<option label="International" value="international">International</option>&#13;
			<option label="Both" value="both">Both</option>&#13;
		</field>&#13;
		<field type="select" label="If traveling Internationally, do you and all your guest have your passport? If not do you have plans to secure the pasport before your travel?" name="if-traveling-internationally-do-you-and-all-your-guest-have-your-passport-if-not-do-you-have-plans-to-secure-the-pasport-before-your-travel" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="textarea" label="Does anyone traveling in your party require any accommodations? (Wheel Chair, Walker) If yes, list their name,&amp;nbsp; the accommodation and if needed at both hotel and airport." name="does-anyone-traveling-in-your-party-require-any-accommodations-wheel-chair-walker-if-yes-list-their-name-the-accommodation-and-if-needed-at-both-hotel-and-airport" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What would you like to include in your Booking? (Select all that apply)" name="checkbox-group-1765252860499">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="All-inclusive Stay" value="allinclusive-stay">All-inclusive Stay</option>&#13;
			<option label="Villa or condo" value="villa-or-condo">Villa or condo</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Airport Transfer" value="airport-transfer">Airport Transfer</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is you per person budget ? If uncertain of specific number give is a range, we need this information to start our search)" name="what-is-you-per-person-budget-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If flying what is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If flying is there any airline you prefer NOT to fly with?" description="i.e. Frontier Spirit" name="if-flying-is-there-any-airline-you-prefer-not-to-fly-with" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Size of Travel Party" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults? (18 and older)" name="how-many-adults-18-and-older" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many children and their ages at time of travel? (17 and under)&amp;nbsp;&amp;nbsp;" name="how-many-children-and-their-ages-at-time-of-travel-17-and-under-" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="text" required="true" label="Please tell us how you found us" name="please-tell-us-how-you-found-us" value="Please tell us how you found us!" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>