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The Door Travel

The Door Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Thank you for selecting Experience Spain!"/>&#13;
		<field type="header" subtype="h1" label="Small Group Pricing"/>&#13;
		<field type="paragraph" subtype="p" label="Small group pricing options are available for up to 3 rooms and 6 travelers.&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="When you enter your information here, the booking will default to 2 travelers at the listed price."/>&#13;
		<field type="paragraph" subtype="p" label="If you would like to add 1–2 more rooms and up to 4 additional travelers, you’ll have the option to request a small group volume discount after booking."/>&#13;
		<field type="header" subtype="h1" label="Personal Information"/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Date of Birth" name="date-of-birth" 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="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Home Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="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" 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="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Credit Card Authorization"/>&#13;
		<field type="paragraph" subtype="p" label="Authorized amount must be at least $2,000."/>&#13;
		<field type="paragraph" subtype="p" label="This is the card that will be used to secure deposits."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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By signing below, I authorize The Door Travel to charge the credit card provided herein.

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