<html> <body> <form-template> <fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field> <field type="header" subtype="h2" label="Questions for Your Trip"/> <field type="header" subtype="h2" label="Primary Traveler Name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" 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" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="select" required="true" label="Preferred method of contact" name="preferred-method-of-contact" className="form-control"> <option label="Call" value="call" selected="selected">Call</option> <option label="Email" value="email">Email</option> <option label="Text" value="text">Text</option> </field> <field type="select" required="true" label="Preferred time to contact" name="preferred-time-to-contact" multiple="multiple" className="form-control"> <option label="Morning" value="Morning" selected="selected">Morning</option> <option label="Afternoon (Between 12:00 p.m. and 5:00 p.m.)" value="Afternoon">Afternoon (Between 12:00 p.m. and 5:00 p.m.)</option> <option label="Evening (Between 5:00 p.m. and 9:00 p.m.)" value="Evening">Evening (Between 5:00 p.m. and 9:00 p.m.)</option> </field> <field type="date" required="true" label="Birthday" name="birthday" 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. (Top 3)" 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" required="true" label="How many nights would you like to be in destination?" name="how-many-nights-would-you-like-to-be-in-destination" subtype="text" className="form-control"/> <field type="text" required="true" label="How many travelers?" description="How many travelers would be able to put down a deposit within a week?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What are you looking for in this experience?" name="what-are-you-looking-for-in-this-experience"> <option label="The best value for your money" value="the-best-value-for-your-money">The best value for your money</option> <option label="The best experience and the highest quality" value="the-best-experience-and-the-highest-quality">The best experience and the highest quality</option> </field> <field type="header" subtype="h2" label="Passport Info"/> <field type="select" label="Do you have a passport?" name="do-you-have-a-passport" className="form-control"> <option label="Yes" value="yes" selected="selected">Yes</option> <option label="No" value="no">No</option> <option label="In progress" value="in-progress">In progress</option> </field> <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"/> <field type="header" subtype="h2" label="Travel Preferences"/> <field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="checkbox-group" label="Describe your flight preferences." description="Check all that apply." name="describe-your-flight-preferences"> <option label="Connecting flights are ok, depending on time and price" value="connecting-flights-are-ok-depending-on-time-and-price">Connecting flights are ok, depending on time and price</option> <option label="Nonstop flights only" value="nonstop-flights-only">Nonstop flights only</option> <option label="Less than 1 hour ride from destination airport to hotel" value="less-than-1-hour-ride-from-destination-airport-to-hotel">Less than 1 hour ride from destination airport to hotel</option> </field> <field type="select" label="Preferred Airline" name="preferred-airline" className="form-control"> <option label="" value=""/> <option label="Southwest Airlines" value="southwest-airlines">Southwest Airlines</option> <option label="Delta Airlines" value="delta-airlines">Delta Airlines</option> <option label="Spirit" value="spirit">Spirit</option> <option label="United Airlines" value="united-airlines">United Airlines</option> <option label="American Airlines" value="american-airlines">American Airlines</option> <option label="Other" value="other">Other</option> </field> <field type="radio-group" label="Seat preference" name="seat-preference"> <option label="Window" value="window">Window</option> <option label="Aisle" value="aisle">Aisle</option> <option label="Opposite aisle" value="opposite aisle">Opposite aisle</option> <option label="Bulkhead" value="bulkhead">Bulkhead</option> <option label="Forward" value="forward">Forward</option> <option label="Wing Seat" value="wing-seat">Wing Seat</option> </field> <field type="radio-group" label="Bed preference" 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" 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="Resort Amenity Preferences" description="Check all that apply" name="resort-amenity-preferences"> <option label="Adults only" value="adults-only">Adults only</option> <option label="All-Inclusive" value="allinclusive">All-Inclusive</option> <option label="Family Friendly" value="family-friendly">Family Friendly</option> <option label="Concierge Level" value="concierge-level">Concierge Level</option> <option label="Suite/Jr. Suite" value="suitejr-suite">Suite/Jr. Suite</option> <option label="On the beach" value="on-the-beach">On the beach</option> <option label="Near City Center" value="near-city-center">Near City Center</option> <option label="Kids Club" value="kids-club">Kids Club</option> <option label="Near Airport/Cruise Port" value="near-airportcruise-port">Near Airport/Cruise Port</option> <option label="Luxury Resort" value="luxury-resort">Luxury Resort</option> <option label="Activities on-site" value="activities-onsite">Activities on-site</option> </field> <field type="radio-group" required="true" label="How much are you willing to invest in this experience PER PERSON?&nbsp;" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$2,300 to $2,500" value="2300-to-2500">$2,300 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="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="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> <option label="Sightseeing " value="sightseeing-">Sightseeing </option> <option label="Shopping" value="shopping">Shopping</option> <option label="Spa" value="spa">Spa</option> <option label="LGBT" value="lgbt">LGBT</option> </field> <field type="select" required="true" label="How soon are you looking to book?" name="how-soon-are-you-looking-to-book" className="form-control"> <option label="Immediately" value="immediately" selected="selected">Immediately</option> <option label="Within the next week" value="within-the-next-week">Within the next week</option> <option label="Within two - three weeks" value="within-two-three-weeks">Within two - three weeks</option> <option label="Within the next month" value="within-the-next-month">Within the next month</option> <option label="Within the next two - three months" value="within-the-next-two-three-months">Within the next two - three months</option> <option label="More than three months" value="more-than-three-months">More than three months</option> </field> <field type="date" required="true" label="Best date to follow up with your proposal:" name="best-date-to-follow-up-with-your-proposal" className="form-control"/> <field type="textarea" label="Are there any dietary restrictions?" name="are-there-any-dietary-restrictions" className="form-control"/> <field type="radio-group" required="true" label="Would you like travel insurance included in your quote?" description="You can always add travel insurance in some capacity later if you choose to decline. A signed waiver will be required if you refuse travel insurance" name="would-you-like-travel-insurance-included-in-your-quote"> <option label="Do NOT quote me travel insurance" value="No travel insurance">Do NOT quote me travel insurance</option> <option label="Please quote me lead-in travel insurance" value="Allianz Classic Plan">Please quote me lead-in travel insurance</option> <option label="Please quote me travel insurance with Cancel For Any Reason Coverage" value="Allianz Classic Plan with Cancel Anytime">Please quote me travel insurance with Cancel For Any Reason Coverage</option> </field> <field type="header" subtype="h1" label="Supplemental Info"/> <field type="radio-group" label="Are you celebrating a special occasion?" name="special-occasion" other="true"> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Birthday" value="birthday">Birthday</option> <option label="Just Because" value="just-because">Just Because</option> </field> <field type="text" label="Where have you vacationed in the past?" name="where-have-you-vacationed-in-the-past" subtype="text" className="form-control"/> <field type="textarea" label="What did you like the most?" name="what-did-you-like-the-most" className="form-control"/> <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"/> </fields> </form-template> </body> </html>
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