<html> <body> <form-template> <fields> <field type="header" subtype="h3" label="Travel Coordinator - Lisandra Vazquez"/> <field type="date" required="true" label="Date of Request (Asterisk (*) indicates required field)&nbsp;" name="date-of-request" className="form-control"/> <field type="radio-group" required="true" label="Is this an estimate or booking request?&nbsp;" name="is-this-an-estimate-or-booking-request-"> <option label="Estimate (if selected, not used for booking)" value="estimate-if-selected-not-used-for-booking">Estimate (if selected, not used for booking)</option> <option label="Booking" value="booking">Booking</option> </field> <field type="radio-group" required="true" label="Is this a RUSH request? (All estimates/bookings will be made within 48 hours of trip approval unless marked RUSH)." name="is-this-a-rush-request-all-estimatesbookings-will-be-made-within-48-hours-of-trip-approval-unless-marked-rush"> <option label="Yes, this is a RUSH request requiring estimate/booking done quickly." value="yes-this-is-a-rush-request-requiring-estimatebooking-done-quickly">Yes, this is a RUSH request requiring estimate/booking done quickly.</option> <option label="No, this is not a RUSH request." value="no-this-is-not-a-rush-request">No, this is not a RUSH request.</option> </field> <field type="text" label="RUSH Requests - How quickly do you need this estimate/booking?" name="rush-requests-how-quickly-do-you-need-this-estimatebooking" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Middle name (if none please say N/A)" name="middle-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="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Preferred Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Charge Code (if multiple charge codes, identify date range applicable to each; IE: if travel extension is planned)&nbsp;" name="charge-code-if-multiple-charge-codes-identify-date-range-applicable-to-each-ie-if-travel-extension-is-planned-" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Services required:&nbsp;" name="services-required-"> <option label="Air" value="air">Air</option> <option label="Lodging" value="lodging">Lodging</option> <option label="Car" value="car">Car</option> <option label="Other" value="other">Other</option> </field> <field type="date" required="true" label="Date of Departure" name="date-of-departure" className="form-control"/> <field type="text" required="true" label="Departure City?" name="departure-city" subtype="text" className="form-control"/> <field type="text" required="true" label="Departing time requests?" name="departing-time-requests" subtype="text" className="form-control"/> <field type="date" required="true" label="Date or return?" name="date-or-return" className="form-control"/> <field type="text" required="true" label="Return time requests?" name="return-time-requests" subtype="text" className="form-control"/> <field type="text" required="true" label="Destination?" name="destination" subtype="text" className="form-control"/> <field type="text" label="If you are traveling as a group, please list the names of the other employees joining the trip and indicate if they are Rothe or Non-Rothe employees." name="if-you-are-traveling-as-a-group-please-list-the-names-of-the-other-employees-joining-the-trip" subtype="text" className="form-control"/> <field type="text" required="true" label="What is the area of town or location that you would like to stay near?&nbsp;" name="what-is-the-area-of-town-or-location-that-you-would-like-to-stay-near-" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Are you required to stay under per diem?" name="are-you-required-to-stay-under-per-diem"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Will you be the primary driver of a rental car (Please coordinate with other travelers in your party. If no one answers yes to this question, no car rental will be made.)" name="will-you-be-the-primary-driver-of-a-rental-car-please-coordinate-with-other-travelers-in-your-party-if-no-one-answers-yes-to-this-question-no-car-rental-will-be-made"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Company Travel Card (Please note you will be sent a secure CC authorization form you will need to fill out before any bookings are made with your company card)" name="company-travel-card-please-note-you-will-be-sent-a-secure-cc-authorization-form-you-will-need-to-fill-out-before-any-bookings-are-made-with-your-company-card"> <option label="Yes, I have a company credit card (required for travel)." value="yes-i-have-a-company-credit-card-required-for-travel">Yes, I have a company credit card (required for travel).</option> <option label="No, I do not have a company credit card, one is on order." value="no-i-do-not-have-a-company-credit-card-one-is-on-order">No, I do not have a company credit card, one is on order.</option> </field> <field type="textarea" required="true" label="Purpose of Trip (Provide ALL additional details needed for an accurate trip request. If not listed in this request form, it will not be accommodated.)" name="purpose-of-trip" className="form-control"/> <field type="textarea" label="Justification for not using Company Preferred Airline (Rothe Only - Southwest)" name="justification-for-not-using-company-preferred-airline-rothe-only-southwest" className="form-control"/> </fields> </form-template> </body> </html>
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