Cynthia Booth

B. Luxe Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (nickname)" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Passport Information"/>&#13;
		<field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Date of birth" name="birthday" className="form-control"/>&#13;
		<field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/>&#13;
		<field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/>&#13;
		<field type="radio-group" label="Sex" name="gender">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female" value="female">Female</option>&#13;
		</field>&#13;
		<field type="file" label="Photo of passport ID page" name="passport_photo" subtype="file" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Important Dates"/>&#13;
		<field type="date" label="Wedding Anniversary" name="wedding-anniversary" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Travel Preferences"/>&#13;
		<field type="radio-group" label="What best describes your travel preference?" name="hotel-preference">&#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="Hotel Rating" inline="true" name="hotel-rating">&#13;
			<option label="3 Star" value="3-star">3 Star</option>&#13;
			<option label="4 Star" value="4-star">4 Star</option>&#13;
			<option label="5 Star" value="5-star">5 Star</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="radio-group" label="Bed preference" name="bed-preference">&#13;
			<option label="King" value="king">King</option>&#13;
			<option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Airline Preference" name="airline-preference" other="true">&#13;
			<option label="Delta Airlines" value="delta-airlines">Delta Airlines</option>&#13;
			<option label="American Airlines" value="american-airlines">American Airlines</option>&#13;
			<option label="United Airlines" value="united-airlines">United Airlines</option>&#13;
			<option label="Southwest Airlines" value="southwest-airlines">Southwest Airlines</option>&#13;
			<option label="Jet Blue Airlines" value="jet-blue-airlines">Jet Blue Airlines</option>&#13;
			<option label="Frontier Airlines" value="frontier-airlines">Frontier Airlines</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="TSA Precheck and/or Global Entry Number" name="tsa-precheck-andor-global-entry-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Seating preference" name="seating-preference">&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Main Cabin" value="main-cabin">Main Cabin</option>&#13;
			<option label="Business Class" value="business-class">Business Class</option>&#13;
			<option label="First Class" value="first-class">First Class</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>