<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Limitless Travel Request Form"/> <field type="checkbox-group" required="true" label="How did you hear about us?" inline="true" name="how-did-you-hear-about-us"> <option label="Select One" value="select-one">Select One</option> <option label="Facebook" value="facebook">Facebook</option> <option label="Instagram" value="instagram">Instagram</option> <option label="Google" value="google">Google</option> <option label="Linkedlin" value="linkedlin">Linkedlin</option> <option label="Referral" value="referral">Referral</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="Referral Name" name="referral-name" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Have you booked with&nbsp; Limitless Travel Gorup previously?" inline="true" name="have-you-booked-with-jeris-world-travel-previously"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Will this be your first time hiring a Travel Advisor?" name="will-this-be-your-first-time-hiring-a-travel-advisor"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Full name as it appears on your passport"/> <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="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Important Dates"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="date" label="Wedding anniversary" name="wedding-anniversary" className="form-control"/> <field type="header" subtype="h2" label="Vacation Details"/> <field type="text" required="true" label="Travel Location/Destination" description="Identify your desired destination name. If you do not hve a specific preference indicat the type of environment you would prefer (ex. beach location)" placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <field type="text" required="true" label="What's the trip occasion? (Ex. Birthday, Wedding. Romanic Getaway. Weekend Getaway., etc.)" name="whats-the-trip-occasion-ex-birthday-wedding-romanic-getaway-etc" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Is this a group trip? ( 8 or more rooms)" name="is-this-a-group-trip-5-or-more-rooms"> <option label="Yes (please answer the question below) " value="yes-please-answer-the-question-below-">Yes (please answer the question below) </option> <option label="No (skip the next question)" value="no-skip-the-next-question">No (skip the next question)</option> </field> <field type="textarea" label="If this is a GROUP TRIP please provide the vision or occasion for this group trip." name="if-this-is-a-group-trip-please-provide-the-vision-or-occasion-for-this-group-trip" 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="select" required="true" label="Are your travel dates flexible?&nbsp;" name="are-your-travel-dates-flexible-" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="What are your flexiable dates?" name="what-are-your-flexiable-dates" subtype="text" className="form-control"/> <field type="select" required="true" label="Please select your preferred place to stay during this vacation." name="please-select-your-preferred-place-to-stay-during-your-vacation" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Hotel" value="hotel">Hotel</option> <option label="Condo" value="condo">Condo</option> <option label="Resort" value="resort">Resort</option> <option label="Cabin" value="cabin">Cabin</option> </field> <field type="select" required="true" label="Will this be an all-inclusive resort vacation?" description="Includes airport transfers all meals beverages and activities" name="will-this-be-an-allinclusive-resort-vacation" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="textarea" required="true" label="What is your ideal vision for your vacation?" name="is-there-anything-else-you-would-like-me-to-know" className="form-control"/> <field type="text" required="true" label="Total Passengers" name="total-passengers" subtype="text" className="form-control"/> <field type="textarea" required="true" label="Number of persons in each room (ex. Room #1=2 adults, 1 youth)&nbsp;" name="number-of-persons-per-room-ex-room-12-adults-1-youth-" className="form-control"/> <field type="text" required="true" label="Number of rooms/cabins needed" name="number-of-roomscabins-needed" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Type of Rooms" inline="true" name="type-of-rooms"> <option label="Single ( 1 King/Queen)" value="single-1-kingqueen">Single ( 1 King/Queen)</option> <option label="Double ( 2 Queen/King)" value="double-2-queenking">Double ( 2 Queen/King)</option> <option label="Suite" value="suite">Suite</option> </field> <field type="checkbox-group" required="true" label="Travel party includes (check all that apply)" inline="true" name="travel-party-includes-check-all-that-apply"> <option label="Seniors (60+)" value="seniors-60">Seniors (60+)</option> <option label="Adults (18-21+)" value="adults-1821">Adults (18-21+)</option> <option label="Children (under 18)" value="children-under-18">Children (under 18)</option> </field> <field type="textarea" label="Please list all individual&nbsp; adult full names and date of birth (as shown on passport)" name="please-list-individual-adult-names-and-date-of-birth-if-available" className="form-control"/> <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="select" required="true" label="Time preference for departure" name="time-preference-for-departure" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Morning Departure" value="morning-departure">Morning Departure</option> <option label="Afternoon" value="afternoon">Afternoon</option> <option label="Early Evening Departure" value="early-evening-departure">Early Evening Departure</option> <option label="Late Evening Departure" value="late-evening-departure">Late Evening Departure</option> </field> <field type="textarea" label="If other parties are departing parting from a different cites list number of travelers and cities. ( Ex. 2 adults, ATL. 3 adults, New Orleans etc. )" name="if-other-parties-are-departing-parting-from-a-different-cites-list-number-of-travelers-and-cities-ex-2-adults-atl-3-adults-new-orleans-etc-" className="form-control"/> <field type="header" subtype="h3" label="Budget: Please be sure to consider cost for flights, hotels, transportation and excursions/entertainment for all in travel party."/> <field type="radio-group" required="true" label="Maximum travel budget amount per person? (Used as a guideline to prepare travel options)" description="This just gives me a general starting point and can always be changed later." name="budget" other="true"> <option label="$1,000 to $1,500" value="1000-to-1500">$1,000 to $1,500</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="checkbox-group" required="true" label="How soon are you prepared to secure your reservation deposit with a deposit?" name="how-soon-are-you-prepared-to-secure-your-reservation-deposit-with-a-deposit"> <option label="Immediately (at time of booking)" value="immediately-at-time-of-booking">Immediately (at time of booking)</option> <option label="1-2 weeks" value="12-weeks">1-2 weeks</option> <option label="3-4 weeks" value="34-weeks">3-4 weeks</option> </field> <field type="text" label="Preferred Suppliers (ex. Cruise Line, Hotel Name, etc.)" name="preferred-suppliers-ex-cruise-line-hotel-name-etc" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Payment Options"/> <field type="select" required="true" label="Please select your payment option" name="please-select-your-payment-option" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="One payment in full" value="one-payment-in-full">One payment in full</option> <option label="Payment plan (deposit +payments)" value="payment-plan-deposit-payments">Payment plan (deposit +payments)</option> </field> <field type="select" label="Would you like information about Uplifts 24 month payment plan? "Travel Now Pay Later"" name="would-you-like-information-about-uplifts-12-month-payment-plan-travel-now-pay-later" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Flight Information&nbsp;"/> <field type="text" label="What is your preferred airline?" name="what-is-your-preferred-airline" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Are you willing to accept layovers?" inline="true" name="are-you-willing-to-accept-layovers"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Layover Preference ( if available)&nbsp; &nbsp;" name="layover-preference-if-available-"> <option label="1hr to 2.5 hrs." value="1hr-to-25-hrs">1hr to 2.5 hrs.</option> <option label="2.5 hrs. to 4hrs." value="25-hrs-to-4hrs">2.5 hrs. to 4hrs.</option> </field> <field type="header" subtype="h2" label="Excursions&nbsp;"/> <field type="textarea" required="true" label="What are you interested in? (Ex. ATV, Horseback Riding, Ziplining etc)" name="what-are-you-interested-in-ex-atv-horseback-riding-ziplining-etc" className="form-control"/> <field type="select" label="Will you need a rental car" name="will-you-need-a-rental-car" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h2" label="Do everyone in your travel party own&nbsp; a valid (not expired) passport?"/> <field type="select" label="Do you have a valid (not expired) passport?" name="do-you-own-a-passport" className="form-control"> <option label="Select One" value="select-one">Select One</option> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="I do not own a passport" value="i-do-not-own-a-passport">I do not own a passport</option> </field> <field type="header" subtype="h2" label="Travel Insurance Acknowledgement&nbsp;"/> <field type="paragraph" subtype="p" label="Emergencies can happen when you least expect them. All vacations booked through Jeri's World Travel included travel insurance to protect your travel investment, cruise lines, airlines, hotels, and tour operators all charge high penalties for cancelation, ranging from the full deposit to no refund at all. And, keep in mind that most health insurance policies will not cover you when you are out of the country. Travel insurance can protect you in the event of Trip Cancelation, Trip Delay, Trip Interruption, Missed Connection, Baggage Loss, Medical Emergency among other unforeseen circumstances. Terms of coverage varies depending on the supplier use to book your vacation.&nbsp;"/> <field type="checkbox-group" required="true" label="Travel Insurance Acknowledgement&nbsp;" name="travel-insurance-acknowledgement-"> <option label="I agree" value="i-agree">I agree</option> </field> <field type="header" subtype="h2" label="Travel Client Agreement"/> <field type="text" label="Please Read Acknowledge the Following Statements&nbsp;" name="please-read-acknowledge-the-following-statements-" value="Statement 1" subtype="text" className="form-control"/> <field type="paragraph" subtype="p" label="LimitlessTravel takes pride in crafting customized itineraries that perfectly align with our clients' individual needs and preferences. To ensure that our team can dedicate the necessary time and attention to curate a tailored proposal specifically for you, we kindly request referrals and reviews after travel services are completed.&nbsp;"/> <field type="checkbox-group" required="true" label="Client Acknowledgement&nbsp;" name="client-acknowledgement-"> <option label="Yes, I understand referrals and reviews is your only request as our travel professional." value="yes-i-understand-referrals-and-reviews-is-your-only-request-as-our-travel-professional">Yes, I understand referrals and reviews is your only request as our travel professional.</option> </field> <field type="paragraph" subtype="p" label="Thank you for completing the travel request form; please take a moment to read the important information above BEFORE before selecting submit. If you need any more help I am certainly here to help during business hours. Please feel free to text, call, or email me respectfully.&nbsp;"/> </fields> </form-template> </body> </html>
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