<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Tell me a little about you"/> <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 required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="When is best to contact you for your complimentary consultation?"/> <field type="select" required="true" label="Day(s) of the Week? Select all that are good for you.&nbsp; I'll be in contact soon.&nbsp;" name="when-is-the-best-time-to-call-you-for-your-complimentary-consultation" multiple="multiple" className="form-control"> <option label="Monday" value="monday" selected="selected">Monday</option> <option label="Tuesday" value="tuesday">Tuesday</option> <option label="Wednesday" value="wednesday">Wednesday</option> <option label="Thursday" value="thursday">Thursday</option> <option label="Friday" value="friday">Friday</option> <option label="Saturday - limited availability" value="saturday-limited-availability">Saturday - limited availability</option> </field> <field type="select" required="true" label="Time of the Day?&nbsp; &nbsp;Select all that are good for you." name="time-of-the-day-select-all-that-are-good-for-you" multiple="multiple" className="form-control"> <option label="Morning 9:00 - 11:30am EST" value="morning-900-1130am-est" selected="selected">Morning 9:00 - 11:30am EST</option> <option label="Afternoon 12:00PM - 4:30PM EST" value="afternoon-1200pm-430pm-est">Afternoon 12:00PM - 4:30PM EST</option> <option label="Evening 5:00PM - 7:00PM" value="evening-500pm-700pm">Evening 5:00PM - 7:00PM</option> </field> <field type="header" subtype="h2" label="Questions for your trip"/> <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="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" required="true" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="Tell me a little about it.&nbsp;" name="tell-me-a-little-about-it-" subtype="text" className="form-control"/> <field type="text" required="true" label="What is your departure city?" description="Where will you be flying from? If more than one city list all." name="departure-city" subtype="text" className="form-control"/> <field type="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later but don't be afraid to be real. I will be sure to get you the most value for your dollar." name="budget"> <option label="$3,000-$5,000" value="30005000">$3,000-$5,000</option> <option label="$5,000 to $6,500" value="5000-to-6500">$5,000 to $6,500</option> <option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option> <option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option> <option label="$10,000+" value="10000">$10,000+</option> </field> <field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers budget and/or travel preferences?" name="notes" className="form-control"/> <field type="text" required="true" label="How did you hear about By Design Memories Travel?" name="how-did-you-hear-about-by-design-memories-travel" subtype="text" className="form-control"/> <field type="checkbox-group" label="Would you like to receive my newsletter?&nbsp; &nbsp;" toggle="true" name="would-you-like-to-receive-my-newsletter-"> <option label="yes" value="yes" selected="selected">yes</option> </field> <field type="header" subtype="h2" label="Passport Info"/> <field type="text" label="Full name as it appears on passport" name="passport-name" subtype="text" className="form-control"/> <field type="text" label="Passport number" name="passport-number" subtype="text" className="form-control"/> <field type="text" label="Country of issue" name="passport-country-of-issue" subtype="text" className="form-control"/> <field type="date" label="Date of issue" name="passport-date-of-issue" className="form-control"/> <field type="date" label="Date of expiration" name="passport-date-of-expiration" className="form-control"/> <field type="radio-group" label="Gender" name="gender"> <option label="F" value="female">F</option> <option label="M" value="male">M</option> <option label="X" value="other">X</option> </field> <field type="text" label="Place of birth" name="place-of-birth" subtype="text" className="form-control"/> <field type="text" label="Nationality" name="nationality" subtype="text" className="form-control"/> <field type="text" label="Citizenship" name="citizenship" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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