<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Full name"/> <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="date" label="Birthday" name="birthday" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Questions for your trip"/> <field type="text" required="true" label="Where would you like to go?" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <field type="text" label="Hotel or Resort Name&nbsp;" placeholder="ex: Hilton" name="hotel-or-resort-name-" 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" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="select" required="true" label="What's the occassion?" name="whats-the-occassion" className="form-control"> <option label="Just need a getaway" value="just-need-a-getaway">Just need a getaway</option> <option label="Family Vacation" value="family-vacation">Family Vacation</option> <option label="Girls Trip" value="girls-trip">Girls Trip</option> <option label="Milestone Birthday" value="milestone-birthday">Milestone Birthday</option> <option label="Anniversary " value="anniversary-">Anniversary </option> <option label="Hanging with the guys" value="hanging-with-the-guys">Hanging with the guys</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="Any Children? If yes, please list their ages" description="17 or under" placeholder="5;7;11" name="any-children-if-yes-please-list-their-ages" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Include Flights" inline="true" name="include-flights"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" required="true" label="Would you like to include Travel Insurance?" description="Provides financial protection against unexpected events such as trip cancellations medical emergencies lost luggage and other travel-related mishaps." inline="true" name="would-you-like-to-include-travel-insurance"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" required="true" label="How many travelers?" description="10 rooms qualify for group rates and special perks" name="number-of-travelers" subtype="text" className="form-control"/> <field type="text" label="What is your departure airport?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="Is everyone departing from the same airport?" description="10 passengers on same flight qualify for group rates" inline="true" name="is-everyone-departing-from-the-same-airport"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="radio-group" label="Bed preference" inline="true" name="bed-preference"> <option label="King" value="king">King</option> <option label="2 Double/Queen" value="2-double-queen">2 Double/Queen</option> </field> <field type="radio-group" label="Hotel preference" inline="true" name="hotel-preference"> <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="Vibe preferences" name="vibe-preference"> <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> <option label="Multi-generational" value="multi-generational">Multi-generational</option> <option label="Adventure" value="adventure">Adventure</option> </field> <field type="checkbox-group" label="Activity preferences" name="activity-preferences"> <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 theatre" value="art-theatre">Arts and theatre</option> </field> <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"/> <field type="radio-group" required="true" label="What is the estimated budget per traveler?" name="budget"> <option label="$750 to $1500" value="750-to-1500">$750 to $1500</option> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 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="radio-group" required="true" label="Are you prepared to make a minimum deposit of $200 per person (quote is only valid for 24hours} ?" name="are-you-prepared-to-make-a-minimum-deposit-of-200-per-person-quote-is-only-valid-for-24hours-"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Payment Options (select the ones that would best suit you)&nbsp;" name="payment-options-select-the-ones-that-would-best-suit-you-"> <option label="Deposit with Payment Plan " value="deposit-with-payment-plan-">Deposit with Payment Plan </option> <option label="Finance with Flexpay (Book Now, Pay Later) " value="finance-with-flexpay-book-now-pay-later-">Finance with Flexpay (Book Now, Pay Later) </option> <option label="Full Payment " value="full-payment-">Full Payment </option> </field> <field type="header" subtype="h1" label="Additional Information"/> <field type="select" label="Promo Code" name="promo-code" className="form-control"> <option label="" value=""/> <option label="Itslovelykena" value="itslovelykena">Itslovelykena</option> <option label="Ryan86p" value="ryan86p">Ryan86p</option> <option label="BKS419" value="bks419">BKS419</option> <option label="FyeBlendz" value="fyeblendz">FyeBlendz</option> <option label="#JUSTSMILET" value="justsmilet">#JUSTSMILET</option> <option label="Prettyblack" value="prettyblack">Prettyblack</option> <option label="2015" value="2015">2015</option> <option label="DOUBLEM" value="doublem">DOUBLEM</option> <option label="LuxxParadise_Travels" value="luxxparadisetravels">LuxxParadise_Travels</option> </field> <field type="text" label="Discount Code" description="Special Offers!!" name="discount-code" subtype="text" className="form-control"/> <field type="text" label="Charity" description="501c3 organization that you would like to support" placeholder="27Strong" name="charity" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="How Did You Hear About Grace Resorts?"/> <field type="radio-group" required="true" label="Please select below" inline="true" name="please-select-below" other="true"> <option label="Social Media" value="social-media">Social Media</option> <option label="Google" value="google">Google</option> <option label="Direct Mail" value="direct-mail">Direct Mail</option> <option label="Email" value="email">Email</option> </field> </fields> </form-template> </body> </html>
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