Share your information with Malinda Davis

Malinda Davis

iTravel, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="FlexPay Information Form"/>&#13;
		<field type="radio-group" required="true" label="&amp;nbsp;Please select all the components of the trip. Multiple selections permitted." name="-please-select-all-the-components-of-the-trip-multiple-selections-permitted">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Vacation Package" value="vacation-package">Vacation Package</option>&#13;
			<option label="Flight" value="flight">Flight</option>&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Other/Add Ons" value="otheradd-ons">Other/Add Ons</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Finance Amount"/>&#13;
		<field type="text" required="true" label="The amount to be financed must be at least $150.00 USD and no more than $15,000.00 USD." description="Amount To Be Financed*" name="the-amount-to-be-financed-must-be-at-least-15000-usd-and-no-more-than-1500000-usd" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Travel Dates&amp;nbsp; -&amp;nbsp; The trip must have an advance purchase window of at least 5 day(s)."/>&#13;
		<field type="date" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Travelers" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Borrowers Name"/>&#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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Is the borrower traveling on this reservation?&amp;nbsp; &amp;nbsp;If no, please complete the below traveler information for each person traveling." name="is-the-borrower-traveling-on-this-reservation">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Traveler 1"/>&#13;
		<field type="text" label="Traveler 1 First Name" name="traveler-1-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Traveler 1 First Name" name="text-1753058978324" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Traveler 1 Birthdate" name="traveler-1-birthdate" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Traveler 2"/>&#13;
		<field type="text" label="Traveler 2 First Name" name="traveler-2-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Traveler 2 Last Name" name="traveler-2-last-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Traveler 2 Birthdate" name="traveler-2-birthdate" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Traveler 3"/>&#13;
		<field type="text" label="Traveler 3 First Name" name="traveler-3-first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Traveler 3 Last Name" name="traveler-3-last-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Traveler 3 Birthdate" name="traveler-3-birthdate" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Once you complete this form, the FlexPay application will be sent to you by email or text."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>