<form-template>
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>
		<field type="text" required="true" label="Name of Couple" name="name-of-couple" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Gift you would like to purchase:" description="Please write the title of the gift in the box." name="gift-you-would-like-to-purchase" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Amount you would like to spend" description="Please write the amount you would like to donate towards the gift." name="amount-you-would-like-to-spend" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="How would you like the couple notified?&amp;nbsp;&amp;nbsp;" description="Please choose one or enter another option.  The couple will not be notified by Ten Palms Travel unless option 2 is chosen." name="how-would-you-like-the-couple-notified-" other="true">
			<option label="I will notify the couple myself when I am ready." value="i-will-notify-the-couple-myself-when-i-am-ready">I will notify the couple myself when I am ready.</option>
			<option label="Please notify the couple on my behalf as soon as the item is purchased." value="please-notify-the-couple-on-my-behalf-as-soon-as-the-item-is-purchased">Please notify the couple on my behalf as soon as the item is purchased.</option>
			<option label="Please mail me a paper certificate for me to present to the couple." value="please-mail-me-a-paper-certificate-for-me-to-present-to-the-couple">Please mail me a paper certificate for me to present to the couple.</option>
			<option label="Please email me a certificate so that I may present it to the couple." value="please-email-me-a-certificate-so-that-i-may-present-it-to-the-couple">Please email me a certificate so that I may present it to the couple.</option>
			<option label="Notify the couple on my behalf while they are on their trip when the service is delivered. " value="notify-the-couple-on-my-behalf-while-they-are-on-their-trip-when-the-service-is-delivered-">Notify the couple on my behalf while they are on their trip when the service is delivered. </option>
		</field>
		<field type="text" label="If you'd like for us to notify the couple for you, please include a personalized message below." name="if-youd-like-for-us-to-notify-the-couple-for-you-please-include-a-personalized-message-below" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Purchaser's First and Last Name" name="purchasers-first-and-last-name" subtype="text" className="form-control"/>
		<field type="text" required="true" label="Purchaser's Email Address&amp;nbsp;" name="purchasers-email-address-" subtype="text" className="form-control"/>
		<field type="radio-group" required="true" label="May we add you to our once-a-week travel tips newsletter?&amp;nbsp;&amp;nbsp;" description="Ten Palms Travel sends out one newsletter per week with current news  specials  and travel tips.  We will not provide your information to ANY other suppliers/corporations.  You may unsubscribe at any time." name="may-we-add-you-to-our-onceaweek-travel-tips-newsletter-">
			<option label="Yes, please " value="yes-please-">Yes, please </option>
			<option label="No thanks " value="no-thanks-">No thanks </option>
			<option label="I already receive your newsletter.  " value="i-already-receive-your-newsletter-">I already receive your newsletter.  </option>
		</field>
		<field type="paragraph" subtype="p" label="Upon receiving this form, Ten Palms Travel will send you an invoice which will allow you to securely authorize payment for your gift.&amp;nbsp; After payment is authorized, your card will be charged within three business days and we will be in touch regarding your option for notifying the couple.&amp;nbsp; &amp;nbsp;Thank you for your generous gift!&amp;nbsp;"/>
	</fields>
</form-template>