Share your information with Bianka Salvador

Bianka Salvador

Zorka's Travel

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  <body>
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	<fields>&#13;
		<field type="text" required="true" label="First Name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" 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="text" required="true" label="Email" name="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="text" required="true" label="Where would you like to discover?" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How much are you planning to invest in your trip? Please note our minimum trip budget is $10,000 per couple." name="budget">&#13;
			<option label="$10,000+ (Minimum South America, Per Week)" value="10000-minimum-south-america-per-week">$10,000+ (Minimum South America, Per Week)</option>&#13;
			<option label="$12,500+ (Minimum Europe , Per Week)" value="12500-minimum-europe-per-week">$12,500+ (Minimum Europe , Per Week)</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
			<option label="$25,000+ (Minimum Africa Budget, Per Week" value="25000-minimum-africa-budget-per-week">$25,000+ (Minimum Africa Budget, Per Week</option>&#13;
			<option label="Whatever it takes to create an unforgettable experience!" value="whatever-it-takes-to-create-an-unforgettable-experience">Whatever it takes to create an unforgettable experience!</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Departure City/Airport" name="departure-cityairport" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Travel Dates &amp;amp; Length of Trip:" description="Exact dates are preferred." name="travel-dates-length-of-trip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What kind of experience (S) are you looking for (check all that apply)" name="vibe-preference" other="true">&#13;
			<option label="Food &amp; Wine" value="food-wine">Food &amp; Wine</option>&#13;
			<option label="Family Travel" value="family-travel">Family Travel</option>&#13;
			<option label="Culture, History &amp; Arts" value="culture-history-arts">Culture, History &amp; Arts</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="River Cruising " value="river-cruising-">River Cruising </option>&#13;
			<option label="Independent Tours" value="independent-tours">Independent Tours</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Meeting &amp; Incentive Travel" value="meeting-incentive-travel">Meeting &amp; Incentive Travel</option>&#13;
			<option label="Adventure/Active" value="adventureactive">Adventure/Active</option>&#13;
			<option label="Escorted/Group Travel" value="escortedgroup-travel">Escorted/Group Travel</option>&#13;
			<option label="Off the Beaten Path" value="off-the-beaten-path">Off the Beaten Path</option>&#13;
			<option label="Wellness Travel" value="wellness-travel">Wellness Travel</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your accommodation preference?" name="hotel-preference" other="true">&#13;
			<option label="Premium (4-4.5 star Properties)" value="premium-445-star-properties">Premium (4-4.5 star Properties)</option>&#13;
			<option label="Boutique (4-5 star Intimate Properties)" value="boutique-45-star-intimate-properties">Boutique (4-5 star Intimate Properties)</option>&#13;
			<option label="Luxury (5 start Properties)" value="luxury-5-start-properties">Luxury (5 start Properties)</option>&#13;
			<option label="Villa (Private, Luxury, Multi-Bedroom Accommodations)" value="villa-private-luxury-multibedroom-accommodations">Villa (Private, Luxury, Multi-Bedroom Accommodations)</option>&#13;
		</field>&#13;
		<field type="text" label="Any specific recommendations for things that I absolutely should do or see?" description="Specific sites  beaches  museums etc." name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like us to know about your trip?" description="Anything important information about your travelers interests or restriction?" name="notes" className="form-control"/>&#13;
		<field type="text" label="How did you hear about us?" name="text-1711758420837" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Would you like to receive our newsletter?" inline="true" name="would-you-like-to-receive-our-newsletter">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
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