Share your information with Krystal Palmer

Krystal Palmer

Luv Luxe Vacay

<html>
  <body>
    <form-template>&#13;
	<fields>&#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" label="Middle name" name="middle-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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth " name="date-of-birth-" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Plans"/>&#13;
		<field type="text" label="Where would you like to go?" 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="date" 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="date" 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="checkbox-group" 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="checkbox-group" required="true" label="Advise if your are inquiring for " name="advise-if-your-are-inquiring-for-">&#13;
			<option label="Hotel and Flight" value="hotel-and-flight">Hotel and Flight</option>&#13;
			<option label="Hotel Only " value="hotel-only-">Hotel Only </option>&#13;
			<option label="Flight Only" value="flight-only">Flight Only</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults?" name="how-many-adults" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many children? " name="how-many-children-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Please list the name and date of birth of each person traveling with you" name="please-list-the-name-and-age-of-each-child-traveling-with-you" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</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="Birthday Celebration" value="birthday-celebration">Birthday Celebration</option>&#13;
			<option label="Girl's Trip" value="girls-trip">Girl's Trip</option>&#13;
			<option label="Couple's Trip" value="couples-trip">Couple's Trip</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Wedding" value="wedding">Wedding</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Air Travel"/>&#13;
		<field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Seat Preference " name="seat-preference-">&#13;
			<option label="First Class" value="first-class">First Class</option>&#13;
			<option label="Economy " value="economy-">Economy </option>&#13;
			<option label="Aisle " value="aisle-">Aisle </option>&#13;
			<option label="Window " value="window-">Window </option>&#13;
			<option label="Middle" value="middle">Middle</option>&#13;
			<option label="Business First Class" value="business-first-class">Business First Class</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Hotel&amp;nbsp; and Resort "/>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="5 Star" value="5-star">5 Star</option>&#13;
			<option label="4 Star" value="4-star">4 Star</option>&#13;
			<option label="3 Star" value="3-star">3 Star</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="All Inclusive" name="all-inclusive">&#13;
			<option label="Yes, absolutely" value="yes-absolutely">Yes, absolutely</option>&#13;
			<option label="No, doesn't have to be" value="no-doesnt-have-to-be">No, doesn't have to be</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Room Preference" name="room-preference">&#13;
			<option label="Standard" value="standard">Standard</option>&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="Suite/Jr. Suite" value="suitejr-suite">Suite/Jr. Suite</option>&#13;
			<option label="Ocean View " value="ocean-view-">Ocean View </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;
			<option label="None" value="none">None</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;
	</fields>&#13;
</form-template>
  </body>
</html>