Vesta Florence

Bugsy Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="GENERAL INFORMATION"/>&#13;
		<field type="checkbox-group" required="true" label="Traveler Type - Note:&amp;nbsp; If you're requesting a group quote from our website, The Caribbean or The Global Wanderlust Tours, please select your preferred destinations in the Travel Details section below." inline="true" name="traveler-type">&#13;
			<option label="Individual" value="individual">Individual</option>&#13;
			<option label="Group" value="group">Group</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Primary Contact 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" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Confirm Email" name="confirm-email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="TRAVEL DETAILS"/>&#13;
		<field type="checkbox-group" required="true" label="Destination Interest:" name="destination-interest">&#13;
			<option label="Cancun" value="cancun">Cancun</option>&#13;
			<option label="Jamaica" value="jamaica">Jamaica</option>&#13;
			<option label="Australia" value="australia">Australia</option>&#13;
			<option label="Bali" value="bali">Bali</option>&#13;
			<option label="Dubai" value="dubai">Dubai</option>&#13;
			<option label="Greece" value="greece">Greece</option>&#13;
			<option label="Paris" value="paris">Paris</option>&#13;
			<option label="South Africa" value="south-africa">South Africa</option>&#13;
			<option label="USA" value="usa">USA</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="If booking for a group, please complete the following:"/>&#13;
		<field type="text" label="Group Name (if applicable)" name="group-name-if-applicable" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Total Number of Travelers:" name="total-number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Type of&amp;nbsp; Group" inline="true" name="type-of-group">&#13;
			<option label="Car Club" value="car-club">Car Club</option>&#13;
			<option label="Couples" value="couples">Couples</option>&#13;
			<option label="Family-Friendly" value="familyfriendly">Family-Friendly</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="For group bookings, please provide the breakdown of travelers"/>&#13;
		<field type="text" required="true" label="How Many Travelers" name="how-many-travelers" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="How many adults (18+)" name="how-many-adults-18" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9+" value="9">9+</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many teenagers (13-17)" name="how-many-teenagers-1317" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9+" value="9">9+</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many children (2-12)" name="how-many-children-212" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9+" value="9">9+</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="How many infants (0-2)" name="how-many-infants-02" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9+" value="9">9+</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="PREFERRED TRAVEL DATES" placeholder="EX: Sept 1-5  2025" name="preferred-travel-dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Does everyone in your travel party have a valid passport?&amp;nbsp; Note: Passport must be valid 6 months from the date of return" name="does-everyone-in-your-travel-party-have-a-valid-passport-note-passport-must-be-valid-6-months-from-the-date-of-return">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="ACCOMMODATION PREFERENCES"/>&#13;
		<field type="checkbox-group" label="Hotel/Resort Category" name="hotelresort-category">&#13;
			<option label="4-Star" value="4star">4-Star</option>&#13;
			<option label="5-Star" value="5star">5-Star</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Balcony" value="balcony">Balcony</option>&#13;
			<option label="Beachfront" value="beachfront">Beachfront</option>&#13;
			<option label="City View" value="city-view">City View</option>&#13;
			<option label="Gardenview " value="gardenview-">Gardenview </option>&#13;
			<option label="Oceanview" value="oceanview">Oceanview</option>&#13;
			<option label="Oceanfront" value="oceanfront">Oceanfront</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Room Type" inline="true" name="room-type">&#13;
			<option label="Single" value="single">Single</option>&#13;
			<option label="Double" value="double">Double</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Connecting Rooms" value="connecting-rooms">Connecting Rooms</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="What kind of vibe are you looking for? (check all that apply)"/>&#13;
		<field type="checkbox-group" label="Preferred Activities:" inline="true" name="preferred-activities">&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="Art &amp; Architecture" value="art-architecture">Art &amp; Architecture</option>&#13;
			<option label="Beach" value="beach">Beach</option>&#13;
			<option label="Cultural" value="cultural">Cultural</option>&#13;
			<option label="Fishing" value="fishing">Fishing</option>&#13;
			<option label="Food/Wine" value="foodwine">Food/Wine</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Health &amp; Wellness" value="health-wellness">Health &amp; Wellness</option>&#13;
			<option label="Horse Back Riding" value="horse-back-riding">Horse Back Riding</option>&#13;
			<option label="Nightlife/Party" value="nightlifeparty">Nightlife/Party</option>&#13;
			<option label="Relaxation" value="relaxation">Relaxation</option>&#13;
			<option label="Shopping" value="shopping">Shopping</option>&#13;
			<option label="Zip Lining" value="zip-lining">Zip Lining</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Dining Preferences" inline="true" name="dining-preferences">&#13;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="Group Dinners" value="group-dinners">Group Dinners</option>&#13;
			<option label="Private Dining" value="private-dining">Private Dining</option>&#13;
		</field>&#13;
		<field type="textarea" label="List any allergies or dietary restrictions for travelers" name="list-any-allergies-or-dietary-restrictions-for-travelers" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What is your budget Per Person?" description="This gives me a general starting point and can  always be changed later" name="what-is-your-budget-per-person">&#13;
			<option label="$1500 - $2500" value="1500-2500">$1500 - $2500</option>&#13;
			<option label="$2500 - $3500" value="2500-3500">$2500 - $3500</option>&#13;
			<option label="$3500- $4500" value="3500-4500">$3500- $4500</option>&#13;
			<option label="$4500 - $5000" value="4500-5000">$4500 - $5000</option>&#13;
			<option label="$5000+" value="5000">$5000+</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="PLEASE NOTE:&amp;nbsp; Any trip that is 45- days from departure will require payment in FULL and a deposit will NOT be accepted."/>&#13;
		<field type="checkbox-group" label="Payment Method" name="payment-method">&#13;
			<option label="Deposit Now" value="deposit-now">Deposit Now</option>&#13;
			<option label="Pay in Full" value="pay-in-full">Pay in Full</option>&#13;
			<option label="Payment Plan Option" value="payment-plan-option">Payment Plan Option</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Travel Insurance (recommended by agent)" name="travel-insurance-recommended-by-agent">&#13;
			<option label="YES" value="yes">YES</option>&#13;
			<option label="NO" value="no">NO</option>&#13;
		</field>&#13;
		<field type="textarea" label="Additional Details We Should Know About ?" name="additional-details-we-should-know-about-" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>