<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Contact Information"/> <field type="text" required="true" label="First name" name="first-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" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" label="Best time to call:" name="best-time-to-call" subtype="text" className="form-control"/> <field type="select" label="Have you been working with a specific Travelooza agent?&nbsp;" name="have-you-been-working-with-a-specific-travelooza-agent-" className="form-control"> <option label="Jana Huse" value="jana-huse" selected="selected">Jana Huse</option> <option label="Kristen Pfeifer" value="kristen-pfeifer">Kristen Pfeifer</option> <option label="Stephanie Benson" value="stephanie-benson">Stephanie Benson</option> <option label="Shonda Meitler" value="shonda-meitler">Shonda Meitler</option> <option label="Katelyn Bozada" value="katelyn-bozada">Katelyn Bozada</option> <option label="Tammie Macias" value="tammie-macias">Tammie Macias</option> <option label="Alejandro Del Villar" value="alejandro-del-villar">Alejandro Del Villar</option> <option label="Emily Wangen" value="emily-wangen">Emily Wangen</option> <option label="Miranda Martinez" value="miranda-martinez">Miranda Martinez</option> </field> <field type="header" subtype="h2" label="Vacation Request"/> <field type="text" required="true" label="Dates of travel, including arrival date in Italy and how many nights you plan to stay: (Are dates flexible?)&nbsp;" name="dates-of-travel-including-arrival-date-in-italy-and-how-many-nights-you-plan-to-stay-are-dates-flexible-" subtype="text" className="form-control"/> <field type="text" required="true" label="Number of people in your party -- total adults and if any children, the ages please:" name="number-of-people-in-your-party-total-adults-and-if-any-children-the-ages-please" subtype="text" className="form-control"/> <field type="checkbox-group" label="Age Group of Adults" name="age-group-of-adults"> <option label="18-30" value="1830">18-30</option> <option label="31-50" value="3150">31-50</option> <option label="51-64" value="5164">51-64</option> <option label="65+" value="65">65+</option> </field> <field type="checkbox-group" required="true" label="Type of Travel&nbsp;" name="type-of-travel-"> <option label="Custom Trip Package - Be on your own schedule. Activities or day tours can be private or shared." value="custom-trip-package-be-on-your-own-schedule-activities-or-day-tours-can-be-private-or-shared">Custom Trip Package - Be on your own schedule. Activities or day tours can be private or shared.</option> <option label="Scheduled Group Tour - join a multi-day, guided group tour with fixed departure dates." value="scheduled-group-tour-join-a-multiday-guided-group-tour-with-fixed-departure-dates">Scheduled Group Tour - join a multi-day, guided group tour with fixed departure dates.</option> <option label="I would like travel specialists to make suggestions based on my interests." value="i-would-like-travel-specialists-to-make-suggestions-based-on-my-interests">I would like travel specialists to make suggestions based on my interests.</option> </field> <field type="checkbox-group" label="When reading through the Italy Tours on Travelooza.com, the tour that sounds perfect to us is:" name="when-reading-through-the-italy-tours-on-traveloozacom-the-tour-that-sounds-perfect-to-us-is"> <option label="Absolute Italy -- 11 day journey across Italy" value="absolute-italy-11-day-journey-across-italy">Absolute Italy -- 11 day journey across Italy</option> <option label="Amazing Amalfi with Metera and Puglia" value="amazing-amalfi-with-metera-and-puglia">Amazing Amalfi with Metera and Puglia</option> <option label="Fine Wines of Tuscany, Piedmont and Cinque Terre" value="fine-wines-of-tuscany-piedmont-and-cinque-terre">Fine Wines of Tuscany, Piedmont and Cinque Terre</option> <option label="Sicilian Secrets and Maltese Mysteries" value="sicilian-secrets-and-maltese-mysteries">Sicilian Secrets and Maltese Mysteries</option> <option label="A Taste of Southern Italy - Rome & Amalfi Culinary Experience" value="a-taste-of-southern-italy-rome-amalfi-culinary-experience">A Taste of Southern Italy - Rome & Amalfi Culinary Experience</option> <option label="Kingdom of the Sun - South Italy" value="kingdom-of-the-sun-south-italy">Kingdom of the Sun - South Italy</option> <option label="Emilia Romagna - Fast cars, fine wines and fine foods" value="emilia-romagna-fast-cars-fine-wines-and-fine-foods">Emilia Romagna - Fast cars, fine wines and fine foods</option> <option label="Iconic Italy -- History tour of Rome and Florence with a stop in Tuscany" value="iconic-italy-history-tour-of-rome-and-florence-with-a-stop-in-tuscany">Iconic Italy -- History tour of Rome and Florence with a stop in Tuscany</option> <option label="We want something custom built based on info provided" value="we-want-something-custom-built-based-on-info-provided">We want something custom built based on info provided</option> </field> <field type="checkbox-group" required="true" label="Transfers and such:" name="transfers-and-such"> <option label="We would like private transfers throughout " value="we-would-like-private-transfers-throughout-">We would like private transfers throughout </option> <option label="We are OK with a mix of private transfers and trains to save a bit on costs and experience another mode of transportation" value="we-are-ok-with-a-mix-of-private-transfers-and-trains-to-save-a-bit-on-costs-and-experience-another-mode-of-transportation">We are OK with a mix of private transfers and trains to save a bit on costs and experience another mode of transportation</option> <option label="We prefer to use all trains and public transportation where possible for a more affordable experience." value="we-prefer-to-use-all-trains-and-public-transportation-where-possible-for-a-more-affordable-experience">We prefer to use all trains and public transportation where possible for a more affordable experience.</option> </field> <field type="textarea" label="Additional Comments&nbsp; -- highlights most important to us, cities not to miss,&nbsp; unique experiences requested, would you like to pair with a cruise?&nbsp; Special occasions celebrating?&nbsp; Relaxing vs. fast-paced trip?&nbsp; What would make this your dream trip?" name="summary-of-what-the-client-is-looking-for-flights-cruise-hotel-" className="form-control"/> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="text" label="Preferred Departure Airport" name="preferred-airport" subtype="text" className="form-control"/> <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="radio-group" label="Level of Accomodation" name="hotel-preference"> <option label="Economy 3*" value="economy-3">Economy 3*</option> <option label="Moderate 4*" value="moderate-4">Moderate 4*</option> <option label="Luxury 5*" value="luxury-5">Luxury 5*</option> <option label="Boutique" value="boutique">Boutique</option> <option label="Private Villa (mainly available Saturday to Saturday" value="private-villa-mainly-available-saturday-to-saturday">Private Villa (mainly available Saturday to Saturday</option> <option label="Agriturismo/Wine Resort" value="agriturismowine-resort">Agriturismo/Wine Resort</option> </field> <field type="radio-group" required="true" label="Adult Per Person Budget for Entire Trip (including flights, lodging, tours, and in country transportation)" name="adult-per-person-budget-for-entire-trip-including-flights-lodging-tours-and-in-country-transportation" other="true"> <option label="$2000-3500" value="20003500">$2000-3500</option> <option label="$3500-5000" value="35005000">$3500-5000</option> <option label="$5000-6000" value="50006000">$5000-6000</option> <option label="$6000+ " value="6000-">$6000+ </option> </field> <field type="radio-group" label="Stage of Planning" name="stage-of-planning"> <option label="I'm definitely going... let's get it planned!" value="im-definitely-going-lets-get-it-planned">I'm definitely going... let's get it planned!</option> <option label="Still dreaming... not sure when we will take this trip" value="still-dreaming-not-sure-when-we-will-take-this-trip">Still dreaming... not sure when we will take this trip</option> </field> </fields> </form-template> </body> </html>
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