Patricia Warren

P Warren Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#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" label="How did you hear about P Warren Travel?" name="how-did-you-hear-about-p-warren-travel" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Have you done any research for your travel? If so what have you found?" name="have-you-done-any-research-for-your-travel-if-so-what-have-you-found" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Address"/>&#13;
		<field type="text" label="Line 1&amp;nbsp;" name="line-1-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2&amp;nbsp;" name="line-2-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City&amp;nbsp;" name="city-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number (including area code)&amp;nbsp;" name="phone-number-including-area-code-" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Preferred method of contact (All quotes will be emailed regardless of method selected)&amp;nbsp;" name="phone-number-with-area-code">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Private Message Via FB" value="private-message-via-fb">Private Message Via FB</option>&#13;
		</field>&#13;
		<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"/>&#13;
		<field type="date" required="true" 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"/>&#13;
		<field type="date" required="true" 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"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Names of Adult Travelers" name="names-of-adult-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children travelers with age for each" name="how-many-children-travelers-with-age-for-each" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Type of Travel" name="type-of-travel" other="true">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Car rental" value="car-rental">Car rental</option>&#13;
			<option label="Flight" value="flight">Flight</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="Activities" value="activities">Activities</option>&#13;
			<option label="Concerts" value="concerts">Concerts</option>&#13;
			<option label="Sporting Events" value="sporting-events">Sporting Events</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What type of Cruise stateroom would you like" name="what-type-of-cruise-stateroom-would-you-like">&#13;
			<option label="Inside " value="inside-">Inside </option>&#13;
			<option label="Ocean View" value="ocean-view">Ocean View</option>&#13;
			<option label="Balcony/veranda" value="balconyveranda">Balcony/veranda</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
			<option label="Superior Suite" value="superior-suite">Superior Suite</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</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="checkbox-group" label="Airline Seat Prefrence" name="airline-seat-prefrence">&#13;
			<option label="Window" value="window">Window</option>&#13;
			<option label="Isle" value="isle">Isle</option>&#13;
			<option label="Doesn't matter to me" value="doesnt-matter-to-me">Doesn't matter to me</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Bed Preference&amp;nbsp;" name="bed-preference-">&#13;
			<option label="1 King" value="1-king">1 King</option>&#13;
			<option label="2 Double/King" value="2-doubleking">2 Double/King</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional info/qualifiers for possible disconts"/>&#13;
		<field type="textarea" label="Age or Date of birth for all travelers" name="age-or-date-of-birth-for-all-travelers" className="form-control"/>&#13;
		<field type="checkbox-group" label="Please select if the&amp;nbsp; below&amp;nbsp; if the below applies to you - must provide proof at travel" name="please-select-if-the-below-if-the-below-applies-to-you-must-provide-proof-at-travel">&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Fire " value="fire-">Fire </option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<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"/>&#13;
		<field type="text" label="Will you be celebrating anything while away?&amp;nbsp;" name="will-you-be-celebrating-anything-while-away-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is there anyone that you would like to invite to go with you?" name="is-there-anyone-that-you-would-like-to-invite-to-go-with-you" subtype="text" className="form-control"/>&#13;
		<field type="file" label="Photo of passport ID page" name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="file" label="Vaccine card photo" name="vaccine_card_photo" subtype="file" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>