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Nicole Brown
TRUE Vacation
<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Full name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <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="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="radio-group" label="Gender (required by some airlines and destinations)" name="gender-required-by-some-airlines-and-destinations" other="true"> <option label="Female" value="female">Female</option> <option label="Male" value="male">Male</option> <option label="Prefer not to answer" value="prefer-not-to-answer">Prefer not to answer</option> </field> <field type="header" subtype="h2" label="Address"/> <field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Important Dates"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/> <field type="date" label="Special Date" name="special-date" className="form-control"/> <field type="text" label="What does your special date represent?" name="what-does-your-special-date-represent" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Vacation Questions"/> <field type="checkbox-group" required="true" label="Thank you for contacting TRUE Vacation." name="checkbox-group-1715955035766"> <option label="I am actively seeking to book a vacation" value="i-am-actively-seeking-to-book-a-vacation">I am actively seeking to book a vacation</option> <option label="I am weighing my options" value="i-am-weighing-my-options">I am weighing my options</option> </field> <field type="radio-group" label="What is your travel budget per person?" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$1,000 to $1,499" value="1000-to-1499">$1,000 to $1,499</option> <option label="$1,500 to $1,999" value="1500-to-1999">$1,500 to $1,999</option> <option label="$2,000 to $2,499" value="2000-to-2499">$2,000 to $2,499</option> <option label="$2,500 to $2,999" value="2500-to-2999">$2,500 to $2,999</option> <option label="$3,000 to $3,499" value="3000-to-3499">$3,000 to $3,499</option> <option label="$3,500 to $4,000" value="3500-to-4000">$3,500 to $4,000</option> </field> <field type="radio-group" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion" other="true"> <option label="Birthday" value="birthday">Birthday</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Honeymoon" value="honeymoon">Honeymoon</option> </field> <field type="text" label="Where would you like to go?" description="If you're not sure just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <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"/> <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"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="text" label="Are there any children (under 18) in your group?&nbsp; &nbsp;If so, how old will the child(ren) be at the time of travel?" name="are-there-any-children-under-18-in-your-group-if-so-how-old-will-the-children-be-at-the-time-of-travel" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Annual Travel Insurance Plan (covers members in your household)"/> <field type="header" subtype="h1" label="For more peace of mind before and during your trip, I encourage you to consider travel protection with benefits for:&nbsp;&nbsp;"/> <field type="paragraph" subtype="p" label="Trip cancellation and interruption- Up to 100% cash back if you have to cancel your trip or cut it short for a covered reason. Emergency medical care- Reimburses expenses related to covered emergency medical or dental care incurred on your trip. Emergency medical transportation- Benefits for medically necessary transportation following a covered injury or illness to get you to care and home after treatment. 24/7 live travel assistance- Experts on call to help with mishaps—from lost passports to travel emergencies, and more. Travel delay- Compensation for meals, accommodations, and transportation expenses due to a covered delay. Baggage loss and delay- Protection for lost, damaged, stolen, or delayed luggage and personal items throughout your trip."/> <field type="checkbox-group" required="true" label="Are you interested in more information." name="are-you-interested-in-more-information"> <option label="Yes, I am interested in more information." value="yes-i-am-interested-in-more-information">Yes, I am interested in more information.</option> <option label="No, I am not interested in more information." value="no-i-am-not-interested-in-more-information">No, I am not interested in more information.</option> </field> <field type="header" subtype="h2" label="Passport Information"/> <field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/> <field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/> <field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/> <field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/> <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="radio-group" required="true" label="Does your passport expire in the next year?" description="If your passport expires within the next year make sure you check destination expiration date requirements." name="does-your-passport-expire-in-the-next-year"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="I do not have a passport " value="i-do-not-have-a-passport-">I do not have a passport </option> </field> <field type="radio-group" label="Gender" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/> <field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/> <field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/> <field type="radio-group" label="Do all travelers have a passport?" name="do-all-travelers-have-a-passport"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="radio-group" label="Seat preference" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Opposite aisle" value="opposite aisle">Opposite aisle</option> </field> <field type="radio-group" label="Bed preference" name="bed-preference"> <option label="King" value="king">King</option> <option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option> </field> <field type="text" label="Meal preference" name="meal-preference" subtype="text" className="form-control"/> <field type="radio-group" label="Hotel preference" name="hotel-preference"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="checkbox-group" label="Vibe preferences" name="vibe-preference"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> <option label="Multi-generational" value="multi-generational">Multi-generational</option> <option label="Adventure" value="adventure">Adventure</option> <option label="LGBT" value="lgbt">LGBT</option> </field> <field type="checkbox-group" label="Activity preferences" name="activity-preferences"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theatre" value="art-theatre">Arts and theatre</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <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"/> <field type="text" required="true" label="What was your favorite vacation? What made it memorable?" name="what-was-your-favorite-vacation-what-made-it-memorable" subtype="text" className="form-control"/> <field type="text" label="Known Traveler Number (KTN)" name="known-traveler-number-ktn" subtype="text" className="form-control"/> <field type="text" label="Redress Control Number" name="redress-control-number" subtype="text" className="form-control"/> <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"/> <field type="header" subtype="h1" label="Emergency Contact"/> <field type="textarea" label="Please list name, telephone number, and relationship" description="Some vendors ask for this information." name="please-list-name-telephone-number-and-relationship" className="form-control"/> <field type="text" required="true" label="Did your email include the FAQ document?&nbsp; Please read the document carefully.&nbsp; If you have any questions, let me know.&nbsp;" name="did-your-email-include-the-faq-document" subtype="text" className="form-control"/> <field type="text" label="Referred By:" name="referred-by" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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