<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Personal 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="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Important Dates"/> <field type="date" required="true" label="Birthdate (including birth year)" description="Please include correct birth year" placeholder="01/31/1980" name="birthday" className="form-control"/> <field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/> <field type="header" subtype="h1" label="Travel Information"/> <field type="text" label="Travel Purpose (Please specify any special occasions)" name="travel-purpose-please-specify-any-special-occasions" subtype="text" className="form-control"/> <field type="text" required="true" label="Where would you like to go?" description="If you're not sure just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <field type="select" required="true" label="What type of vacation are you interested in?" description="All-inclusive resorts generally do not exist outside of Mexico and the Caribbean. Please only select this option if your request is in one of these destinations or are requesting a specific hotel you know has an all-inclusive option." name="what-type-of-vacation-are-you-interested-in" className="form-control"> <option label="Africa" value="africa">Africa</option> <option label="Asia" value="asia">Asia</option> <option label="Caribbean (All-Inclusive)" value="caribbean-allinclusive">Caribbean (All-Inclusive)</option> <option label="Cruise" value="cruise">Cruise</option> <option label="Disney or Universal Studios" value="disney-or-universal-studios">Disney or Universal Studios</option> <option label="Domestic (United States)" value="domestic-united-states">Domestic (United States)</option> <option label="Europe" value="europe">Europe</option> <option label="Mexico (All-Inclusive)" value="mexico-allinclusive">Mexico (All-Inclusive)</option> <option label="Mexico/Caribbean (Not All-inclusive)" value="mexicocaribbean-not-allinclusive">Mexico/Caribbean (Not All-inclusive)</option> </field> <field type="date" required="true" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/> <field type="date" required="true" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="text" required="true" label="How many&nbsp; adult travelers (18 years and older)?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="textarea" required="true" label="How many rooms are needed?" name="how-many-rooms-are-needed" className="form-control"/> <field type="text" required="true" label="How many children? Please list children's ages at time of travel.&nbsp;" name="how-many-children-please-list-childrens-ages-at-time-of-travel-" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What is your per person budget?" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$2,000 to $4,000" value="2000-to-4000">$2,000 to $4,000</option> <option label="$4,000 to $6,000" value="4000-to-6000">$4,000 to $6,000</option> <option label="above $6,000" value="above-6000">above $6,000</option> </field> <field type="radio-group" required="true" label="Are you interested in travel insurance?" name="are-you-interested-in-travel-insurance"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Not sure, please include with quote and I will decide later" value="not-sure-please-include-with-quote-and-i-will-decide-later">Not sure, please include with quote and I will decide later</option> </field> <field type="checkbox-group" required="true" label="What do you need included in the itinerary?" toggle="true" name="what-do-you-need-included-in-the-itinerary"> <option label="Airfare" value="airfare">Airfare</option> <option label="Accommodations (Hotel/Resort)" value="accommodations-hotelresort">Accommodations (Hotel/Resort)</option> <option label="Accommodations (Pre and/or Post Cruise)" value="accommodations-pre-andor-post-cruise">Accommodations (Pre and/or Post Cruise)</option> <option label="All-Inclusive (Mexico & Caribbean)" value="allinclusive-mexico-caribbean">All-Inclusive (Mexico & Caribbean)</option> <option label="Ground Transportation" value="ground-transportation">Ground Transportation</option> <option label="Activities/Excursions" value="activitiesexcursions">Activities/Excursions</option> </field> <field type="header" subtype="h1" label="Flight Information"/> <field type="select" required="true" label="Would you like flights included with the quote?" name="would-you-like-flights-included-with-the-quote" className="form-control"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" label="Airline Preference" name="airline-preference" subtype="text" className="form-control"/> <field type="select" label="Air Seat Preference" name="air-seat-preference" className="form-control"> <option label="Aisle" value="aisle">Aisle</option> <option label="Window" value="window">Window</option> <option label="Economy" value="economy">Economy</option> <option label="Economy Plus/Premium Economy (extra leg room - extra cost)" value="economy-pluspremium-economy-extra-leg-room-extra-cost">Economy Plus/Premium Economy (extra leg room - extra cost)</option> <option label="First/Business Class" value="firstbusiness-class">First/Business Class</option> </field> <field type="header" subtype="h1" label="Additional Information"/> <field type="select" required="true" label="When are you looking to book your trip?" name="when-are-you-looking-to-book-your-trip" className="form-control"> <option label="Today!" value="today">Today!</option> <option label="This week (if the price is right)" value="this-week-if-the-price-is-right">This week (if the price is right)</option> <option label="In the next 30 days" value="in-the-next-30-days">In the next 30 days</option> <option label="I'm not sure, I am just researching my options" value="im-not-sure-i-am-just-researching-my-options">I'm not sure, I am just researching my options</option> </field> <field type="select" label="If applicable, are you interested in financing (buy now, pay later)?" name="if-applicable-are-you-interested-in-financing-buy-now-pay-later" className="form-control"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="select" label="How would you like to pay for your travel?" name="how-would-you-like-to-pay-for-your-travel" className="form-control"> <option label="I want to pay for everything at booking" value="i-want-to-pay-for-everything-at-booking">I want to pay for everything at booking</option> <option label="I'd like to put down a deposit and pay for my final balance on the due date (if applicable)" value="id-like-to-put-down-a-deposit-and-pay-for-my-final-balance-on-the-due-date-if-applicable">I'd like to put down a deposit and pay for my final balance on the due date (if applicable)</option> <option label="I'm interested in a monthly payment plan" value="im-interested-in-a-monthly-payment-plan">I'm interested in a monthly payment plan</option> </field> <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> </field> <field type="checkbox-group" label="Does your party include any of the following?" toggle="true" name="does-your-party-include-any-of-the-following"> <option label="Infant(s)/Toddler(s)/Children 2 years or younger" value="infantstoddlerschildren-2-years-or-younger">Infant(s)/Toddler(s)/Children 2 years or younger</option> <option label="Fire or Police" value="fire-or-police">Fire or Police</option> <option label="Military (Enlisted or Veteran)" value="military-enlisted-or-veteran">Military (Enlisted or Veteran)</option> <option label="Person(s) with Disabilities" value="persons-with-disabilities">Person(s) with Disabilities</option> <option label="Seniors (55+ year of age)" value="seniors-55-year-of-age">Seniors (55+ year of age)</option> </field> <field type="checkbox-group" required="true" label="Do you have any dietary restrictions, food allergies, or special dietary preferences we should be aware of?"" toggle="true" name="checkbox-group-1738694235496"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="If yes, please provide your meal preference" name="meal-preference" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Do you have any mobility limitations, accessibility needs, or special accommodations we should be aware of to ensure your comfort during your trip?" toggle="true" name="checkbox-group-1738694533103"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="If yes, please provide details so we can make the necessary arrangements for you." name="text-1738694550173" subtype="text" className="form-control"/> <field type="text" label="Anything you absolutely must do or see?" name="text-1738694309092" subtype="text" className="form-control"/> <field type="textarea" required="true" label="How did you hear about my services?&nbsp;" name="notes" className="form-control"/> <field type="checkbox-group" required="true" label="Please allow 4 business day after submission for a response" name="please-allow-3-business-day-after-submission-for-a-response"> <option label="I accept" value="i-accept">I accept</option> </field> <field type="header" subtype="h1" label="Terms &amp; Conditions *"/> <field type="paragraph" subtype="p" label="Please note that our trip-planning service is FREE! We are compensated by the cruise lines, tour operators, resorts, and hotels. We reserve the right to charge a service fee for the time involved with planning your trip under certain circumstances."/> <field type="paragraph" subtype="p" label="The primary circumstance in which we could charge a travel planning fee is if you completely change your travel itinerary. For example, after completing this form, you ask us to plan a Caribbean cruise, but you tell us that you want a vacation to Hawaii instead during the research phase. This type of change would require a Travel Planning Fee."/> <field type="paragraph" subtype="p" label="Any trip requests that will commence in less than 90 days may require a non-refundable rush fee of $90.00."/> <field type="paragraph" subtype="p" label="THE FEE WILL BE CHARGED BEFORE WE BEGIN RESEARCHING THE ALTERNATE TRAVEL DESTINATION AND COLLECTED VIA PAYPAL OR OTHER METHODS AS OUTLINED. ALL SERVICE FEES ARE NON-REFUNDABLE."/> <field type="paragraph" subtype="p" label="By submitting this form, I agree that I have accurately described the trip details that I want to take. I have made my best effort to provide accurate spellings of names and accurate dates of birth for myself and other travelers (if provided). I acknowledge that it is my responsibility to confirm the accuracy of these passenger details when the final booking is completed and promptly notify us of any corrections."/> <field type="paragraph" subtype="p" label="You have read and agree to the: - Above Terms and Conditions - Our Terms and Services: https://www.epicureanescapes.net/terms-of-service and - Our Client Agreement: https://epicureanescapes.net/copy-of-terms-of-service#client-terms-and-conditions By clicking accept below:"/> <field type="checkbox-group" required="true" label="Terms &amp; Conditions" name="terms-conditions"> <option label="I accept" value="i-accept">I accept</option> </field> </fields> </form-template> </body> </html>
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