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Lift'D & Beyond

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Travel Request Form"/>&#13;
		<field type="paragraph" subtype="p" label="Please complete all ﬁelds with details about your travel needs."/>&#13;
		<field type="paragraph" subtype="p" label="Thank you for taking interest in Lift&#39;D &amp;amp; Beyond for your travel needs         We will work to get you the best valued package available that meets your needs. Please provide as many details as possible to aid in the booking of your travel and you will be contacted within 2-3 business days to discuss your trip in detail. Before processing your request, there is a custom travel planning fee required to begin researching and preparing your customized travel quote and is only valid for three (3) quotes for one (1) destination and will expire after thirty (30) days. This fee will be applied toward your booking if you decide to move forward. If you choose not to book, the fee is non-refundable and non-transferable."/>&#13;
		<field type="text" required="true" label="First name" description="Main Traveler Name (as it appears on your Passport or Government Issued ID)" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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="date" required="true" label="Date of Birth" name="birthday" className="form-control"/>&#13;
		<field type="text" label="Street Address" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Street Address Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip Code" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="text" subtype="tel" required="true" label="Phone Number" name="phone-number" className="form-control"/>&#13;
		<field type="text" subtype="email" required="true" label="E-mail" placeholder="example@example.com" name="email" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Additional Travelers:"/>&#13;
		<field type="text" label="Legal Name (As Appears on ID)" name="additional-traveler-legal-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthdate" name="additional-traveler-birthdate" className="form-control"/>&#13;
		<field type="text" label="Legal Name (As Appears on ID)" name="text-1775144008370" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthdate" name="date-1775144020724" className="form-control"/>&#13;
		<field type="text" label="Legal Name (As Appears on ID)" name="text-1775144011042" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthdate" name="date-1775144019896" className="form-control"/>&#13;
		<field type="radio-group" label="Do you and your travelers have a REAL ID?" name="real-id" 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" required="true" label="Please check the type of travel services you need (select all that apply):" name="type-of-travel-services" other="true" className="checkbox-group">&#13;
			<option label="All-inclusive" value="all-inclusive">All-inclusive</option>&#13;
			<option label="Airline Tickets" value="airline-tickets">Airline Tickets</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Hotel/Accommodations" value="hotel-accommodations">Hotel/Accommodations</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Tours or Activities" value="tours-or-activities">Tours or Activities</option>&#13;
			<option label="Transportation To &amp; From Hotel" value="transportation-hotel">Transportation To &amp; From Hotel</option>&#13;
			<option label="Travel Insurance" value="travel-insurance">Travel Insurance</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Type of Trip / Special Occasion (select all that apply)" name="trip-type" other="true" className="checkbox-group">&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Business" value="business">Business</option>&#13;
			<option label="Family Vacation" value="family-vacation">Family Vacation</option>&#13;
			<option label="Getaway" value="getaway">Getaway</option>&#13;
			<option label="Group" value="group">Group</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do any travelers have accessibility or special needs requirements?" description="ex. Wheelchair  Oxygen  Food Allergies  Medical Conditions*Please list any special needs requests here along with their names." name="special-needs-requirements" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your max budget for this trip?" description="*Per Person" placeholder="$" name="max-budget" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What type of payment arrangement would you like?" name="payment-arrangement" className="checkbox-group">&#13;
			<option label="BOOK NOW, PAY NOW" value="book-now-pay-now">BOOK NOW, PAY NOW</option>&#13;
			<option label="DEPOSIT NOW, PAY INSTALLMENTS" value="deposit-now-pay-installments">DEPOSIT NOW, PAY INSTALLMENTS</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="TRAVEL DETAILS"/>&#13;
		<field type="text" label="Departure City" description="*Please list City &amp;amp; State or Airport you prefer." placeholder="ex. Los Angeles  CA" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Destination" description="*Please list City and/or country you want to visit." placeholder="ex. Venice  Italy" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?" name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="ending-at" className="form-control"/>&#13;
		<field type="radio-group" label="Are Your Dates Flexible?" inline="true" name="dates-flexible" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="FLIGHT DETAILS"/>&#13;
		<field type="radio-group" label="Do you require ﬂights?" description="If Yes  please ﬁll in all&amp;nbsp;the ﬁelds below. If No  please click next." name="require-flights" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="ACCOMMODATIONS"/>&#13;
		<field type="radio-group" label="Do you require accommodations (Hotel/Resort/Vacation Rental)?" description="If Yes  please ﬁll in all&amp;nbsp;the ﬁelds below. If No  please click next." name="require-accommodations" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="CRUISE INFORMATION"/>&#13;
		<field type="radio-group" label="Are you requesting a Cruise?" description="If Yes  please ﬁll in all&amp;nbsp;the ﬁelds below. If No  please click next." name="request-cruise" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#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="h3" label="FINAL STEPS"/>&#13;
		<field type="textarea" label="Anything else you&#39;d like us to know?" description="*Please indicate any other travel needs  details  health concerns or special requests for this trip." name="anything-else" className="form-control"/>&#13;
		<field type="radio-group" label="Have you already researched pricing for this trip?" inline="true" name="already-researched" className="radio-group">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="Before submitting, please read: I acknowledge that the information I have provided is accurate to the best of my knowledge. I understand that my deposit, if trip is booked, is non-refunable and other cancellation penalties will apply depending on the cancel date. I understand that all monies must be paid by the ﬁnal payment date, if my balance is left unpaid, my booking will be canceled and is non-refundable. *If travel insurance is purchased, it may cover any non-refundable fees depending on Coverage and Cancellation Policy, minus the cost of Travel Insurance. For this reason, purchasing travel insurance is highly recommended."/>&#13;
		<field type="text" required="true" label="Electronic Signature" description="*Please provide an electronic signature" name="electronic-signature" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Custom Travel Planning Fee" description="$25 researching a trip for a total of 1-5 people. $50 researching a trip for a total of 6-10 people. $75 researching a trip for a total of 11+ people. Research fee is only valid for three (3) quotes for one (1) destination and will expire after thirty (30) days. This fee will be applied toward your booking if you decide to move forward. If you choose not to book  the fee is non-refundable and non-transferable." name="research-fee" className="checkbox-group">&#13;
			<option label="Custom Travel Planning  $25.00" value="custom-travel-planning-2500">Custom Travel Planning  $25.00</option>&#13;
			<option label="Custom Travel Planning  $50.00" value="custom-travel-planning-5000">Custom Travel Planning  $50.00</option>&#13;
			<option label="Custom Travel Planning  $75.00" value="custom-travel-planning-7500">Custom Travel Planning  $75.00</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Quantity" name="research-fee-quantity" value="1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Total" name="total-amount" value="$25.00" subtype="text" className="form-control field-hidden"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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