Share your information with Esty Steffen

Esty Steffen

Briar & Main Travel Boutique

<html>
  <body>
    <form-template>
	<fields>
		<field type="header" subtype="h1" label="CLIENT INFORMATION"/>
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>
		<field type="header" subtype="h1" label="ABOUT YOUR TRIP"/>
		<field type="text" label="Where would you like to go?&amp;nbsp;" name="where-would-you-like-to-go-" subtype="text" className="form-control"/>
		<field type="date" label="When would you like to depart?&amp;nbsp;" name="when-would-you-like-to-depart-" className="form-control"/>
		<field type="date" label="When would you like to return?&amp;nbsp;" name="when-would-you-like-to-return-" className="form-control"/>
		<field type="radio-group" label="Are your dates flexible?&amp;nbsp;" name="are-your-dates-flexible-">
			<option label="Yes" value="yes">Yes</option>
			<option label="No" value="no">No</option>
		</field>
		<field type="text" label="What is your departure city?&amp;nbsp;" name="what-is-your-departure-city-" subtype="text" className="form-control"/>
		<field type="textarea" label="Is this vacation to celebrate anything special?&amp;nbsp;" name="is-this-vacation-to-celebrate-anything-special-" className="form-control"/>
		<field type="textarea" label="Who will be traveling? Please list all full names (including middle) and birthdays&amp;nbsp;" name="who-will-be-traveling-please-list-all-full-names-including-middle-and-birthdays-" className="form-control"/>
		<field type="radio-group" label="At what phase of planning are you in?&amp;nbsp;" name="at-what-phase-of-planning-are-you-in-">
			<option label="I’m just beginning the planning process" value="im-just-beginning-the-planning-process">I’m just beginning the planning process</option>
			<option label="We have dates, but no other details confirmed" value="we-have-dates-but-no-other-details-confirmed">We have dates, but no other details confirmed</option>
			<option label="We have hotels and flights already booked" value="we-have-hotels-and-flights-already-booked">We have hotels and flights already booked</option>
		</field>
		<field type="radio-group" required="true" label="What is your budget for all travelers? This just gives me a general starting point and can always be changed later.&amp;nbsp;" name="what-is-your-budget-for-all-travelers-this-just-gives-me-a-general-starting-point-and-can-always-be-changed-later-">
			<option label="$3,000 - $5,000" value="3000-5000">$3,000 - $5,000</option>
			<option label="$5,000 - $7,500" value="5000-7500">$5,000 - $7,500</option>
			<option label="$7,500 - $10,000" value="7500-10000">$7,500 - $10,000</option>
			<option label="$10,000 - $15,000" value="10000-15000">$10,000 - $15,000</option>
			<option label="$15,000+" value="15000">$15,000+</option>
		</field>
		<field type="textarea" label="Will you be booking any portion of your trip with points? If so, which pieces?&amp;nbsp;" name="will-you-be-booking-any-portion-of-your-trip-with-points-if-so-which-pieces-" className="form-control"/>
		<field type="checkbox-group" label="What travel components would you like us to assist you with? Check all that apply.&amp;nbsp;" name="what-travel-components-would-you-like-us-to-assist-you-with-check-all-that-apply-">
			<option label="Flights" value="flights" selected="selected">Flights</option>
			<option label="Accommodations" value="accommodations">Accommodations</option>
			<option label="Transportation (car rental, trains, etc.)" value="transportation-car-rental-trains-etc">Transportation (car rental, trains, etc.)</option>
			<option label="Excursions &amp; tours" value="excursions-tours">Excursions &amp; tours</option>
			<option label="Insurance" value="insurance">Insurance</option>
			<option label="Other" value="other">Other</option>
		</field>
		<field type="checkbox-group" label="What best describes your desired accommodation style?&amp;nbsp;" name="what-best-describes-your-desired-accommodation-style-">
			<option label="Luxury &amp; exclusive" value="luxury-exclusive" selected="selected">Luxury &amp; exclusive</option>
			<option label="Boutique &amp; charming" value="boutique-charming">Boutique &amp; charming</option>
			<option label="Centrally located &amp; functional" value="centrally-located-functional">Centrally located &amp; functional</option>
			<option label="Large resort" value="large-resort">Large resort</option>
			<option label="Other" value="other">Other</option>
		</field>
		<field type="textarea" label="What are your amenity must-haves?&amp;nbsp;" placeholder="i.e. bar, on-site restaurant, pool, etc." name="what-are-your-amenity-musthaves-" className="form-control"/>
		<field type="checkbox-group" label="What options best describe your travel priorities? Check all that apply.&amp;nbsp;" name="what-options-best-describe-your-travel-priorities-check-all-that-apply-">
			<option label="Local culture &amp; education" value="local-culture-education" selected="selected">Local culture &amp; education</option>
			<option label="Art &amp; architecture" value="art-architecture">Art &amp; architecture</option>
			<option label="Food &amp; wine" value="food-wine">Food &amp; wine</option>
			<option label="Adventure" value="adventure">Adventure</option>
			<option label="Dramatic views &amp; landscapes" value="dramatic-views-landscapes">Dramatic views &amp; landscapes</option>
			<option label="Spa &amp; wellness" value="spa-wellness">Spa &amp; wellness</option>
			<option label="Rest &amp; relaxation" value="rest-relaxation">Rest &amp; relaxation</option>
		</field>
		<field type="textarea" label="Is there anything else that you “must do” or see?&amp;nbsp;" name="is-there-anything-else-that-you-must-do-or-see-" className="form-control"/>
		<field type="textarea" label="What else would you like me to know about your ideal vacation?&amp;nbsp;" name="what-else-would-you-like-me-to-know-about-your-ideal-vacation-" className="form-control"/>
		<field type="textarea" label="Do any travelers have allergies that we should be aware of?&amp;nbsp;" description="We will do our best to accommodate " name="do-any-travelers-have-allergies-that-we-should-be-aware-of-" className="form-control"/>
		<field type="text" label="Who can we thank for referring you to us?&amp;nbsp;" name="who-can-we-thank-for-referring-you-to-us-" subtype="text" className="form-control"/>
		<field type="select" label="Would you like to be subscribed to our company newsletter?&amp;nbsp;" name="would-you-like-to-be-subscribed-to-our-company-newsletter-" className="form-control">
			<option label="Yes- sign me up!" value="yes-sign-me-up" selected="selected">Yes- sign me up!</option>
			<option label="No, I get too many emails" value="no-i-get-too-many-emails">No, I get too many emails</option>
		</field>
	</fields>
</form-template>
  </body>
</html>