Share your information with Euphoric Escapes Travel Company

Euphoric Escapes Travel Company

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="TRAVEL QUOTE REQUEST FORM"/>&#13;
		<field type="paragraph" subtype="p" label="We&#39;re excited to offer a tailored quote proposal for your upcoming travel. Please share the details of your trip with us to get started!"/>&#13;
		<field type="header" subtype="h3" label="Personal Information:"/>&#13;
		<field type="paragraph" subtype="p" label="How can we contact you?"/>&#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" 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" subtype="tel" required="true" label="Phone Number" description="Format: (000) 000-0000." placeholder="(000) 000-0000" name="phone-number" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="Email" description="example@example.com" name="email" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Tell Us About Your Travel Plans"/>&#13;
		<field type="date" required="true" label="Preferred Departure Date?" placeholder="MM/DD/YYYY" name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="Preferred Return Date?" placeholder="MM/DD/YYYY" name="ending-at" className="form-control"/>&#13;
		<field type="text" label="Are your travel dates flexible? Please explain." name="are-your-travel-dates-flexible" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Please specify the travel arrangements you would like included in your quote proposal. Select all that apply." name="travel-arrangements-included" other="true" className="checkbox-group">&#13;
			<option label="Hotel / Resort" value="Hotel / Resort">Hotel / Resort</option>&#13;
			<option label="Cruise" value="Cruise">Cruise</option>&#13;
			<option label="Rental Home / Apartment / Condo" value="Rental Home / Apartment / Condo">Rental Home / Apartment / Condo</option>&#13;
			<option label="Luxury Villa" value="Luxury Villa">Luxury Villa</option>&#13;
			<option label="Air" value="Air">Air</option>&#13;
			<option label="Car Rental" value="Car Rental">Car Rental</option>&#13;
			<option label="Train" value="Train">Train</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="TELL US ABOUT THE TRAVELERS"/>&#13;
		<field type="text" required="true" label="Please indicate the number of adults and children who will be traveling." placeholder="e.g.  23" name="number-of-adults-and-children-12-and-above" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Please indicate the number of adults and children aged 12 and above who will be traveling." placeholder="e.g.  23" name="text-1782691956544" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="text" label="Please specify the total number of children under 12 that will be traveling and provide their ages at time of travel (if known)." placeholder="e.g.  23" name="number-of-children-under-12" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="checkbox-group" label="Please let us know if a traveler qualifies for:" name="traveler-qualifications" className="checkbox-group">&#13;
			<option label="U.S. Military" value="U.S. Military">U.S. Military</option>&#13;
			<option label="Fire Department or EMT" value="Fire Department or EMT">Fire Department or EMT</option>&#13;
			<option label="Age 55+" value="Age 55+">Age 55+</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="WHAT ELSE WOULD YOU LIKE TO TELL US"/>&#13;
		<field type="textarea" required="true" label="Tell us about your ideal trip. (Explain what it is you are looking for us to do for you, including excursions)" name="textarea-1782691608345" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are you traveling for a special event or special occasion?" name="special-event" other="true" className="checkbox-group">&#13;
			<option label="Family Reunion/Getaway" value="Family Reunion/Getaway">Family Reunion/Getaway</option>&#13;
			<option label="Friends Getaway" value="Friends Getaway">Friends Getaway</option>&#13;
			<option label="Birthday" value="Birthday">Birthday</option>&#13;
			<option label="Honeymoon" value="Honeymoon">Honeymoon</option>&#13;
			<option label="Anniversary" value="Anniversary">Anniversary</option>&#13;
			<option label="Spring Break/Retreat" value="Spring Break/Retreat">Spring Break/Retreat</option>&#13;
			<option label="Destination Wedding/Vow Renewal" value="Destination Wedding/Vow Renewal">Destination Wedding/Vow Renewal</option>&#13;
			<option label="Girl/Guy Getaway" value="Girl/Guy Getaway">Girl/Guy Getaway</option>&#13;
		</field>&#13;
		<field type="textarea" label="Does anyone in the traveling party have special needs (e.g. mobility, accessibility, dietary, allergy)?" name="special-needs" className="form-control"/>&#13;
		<field type="text" required="true" label="Setting a budget, what is the maximum amount you are willing to spend per person?" placeholder="e.g.  23" name="budget" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Have you ever worked with a Travel Agent before?" name="worked-with-travel-agent-before" className="radio-group">&#13;
			<option label="Yes" value="Yes">Yes</option>&#13;
			<option label="No" value="No">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="How did you hear about us?" name="how-did-you-hear-about-us" other="true" className="checkbox-group">&#13;
			<option label="Repeat Client" value="Repeat Client">Repeat Client</option>&#13;
			<option label="Friend" value="Friend">Friend</option>&#13;
			<option label="Family" value="Family">Family</option>&#13;
			<option label="Associate" value="Associate">Associate</option>&#13;
			<option label="Ad/Promotion" value="Ad/Promotion">Ad/Promotion</option>&#13;
			<option label="Google Search" value="Google Search">Google Search</option>&#13;
			<option label="Facebook" value="Facebook">Facebook</option>&#13;
			<option label="Instagram" value="Instagram">Instagram</option>&#13;
			<option label="YouTube" value="YouTube">YouTube</option>&#13;
			<option label="LinkedIn" value="LinkedIn">LinkedIn</option>&#13;
			<option label="Business website" value="Business website">Business website</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="If we find exactly what you are looking for, within budget, are you ready to secure the booking with a payment?" name="ready-to-secure-booking" other="true" className="radio-group">&#13;
			<option label="Pay in full today" value="Pay in full today">Pay in full today</option>&#13;
			<option label="Today with a deposit" value="Today with a deposit">Today with a deposit</option>&#13;
			<option label="In a week with a deposit" value="In a week with a deposit">In a week with a deposit</option>&#13;
			<option label="In 2 weeks with a deposit" value="In 2 weeks with a deposit">In 2 weeks with a deposit</option>&#13;
			<option label="In the 30 days with a deposit" value="In the 30 days with a deposit">In the 30 days with a deposit</option>&#13;
			<option label="Just seeking information for planning purposes" value="Just seeking information for planning purposes">Just seeking information for planning purposes</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>