Share your information with DASHAWN PRATT

DASHAWN PRATT

BOUGIE TRAVEL

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Contact Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="DOB" description="MM/DD/YYYY" name="dob" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="checkbox-group" required="true" label="Are you deposit ready? Deposits range from $100-$500 per person&amp;nbsp; for land only" description="Flights will need to be paid in full at the time of booking" name="are-you-deposit-ready-deposits-range-from-100500-per-person-for-land-only">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Departure City (only complete if&amp;nbsp; flights are needed)" name="departure-city-only-complete-if-flights-are-needed" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<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"/>&#13;
		<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"/>&#13;
		<field type="header" subtype="h1" label="Package Options"/>&#13;
		<field type="checkbox-group" required="true" label="Select all that apply" name="select-all-that-apply">&#13;
			<option label="Hotel " value="hotel-">Hotel </option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Hotel and Flight" value="hotel-and-flight">Hotel and Flight</option>&#13;
			<option label="Hotel, Flight and Car rental " value="hotel-flight-and-car-rental-">Hotel, Flight and Car rental </option>&#13;
			<option label="Car rental" value="car-rental">Car rental</option>&#13;
			<option label="Vacation home" value="vacation-home">Vacation home</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many Adult travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many children travelers?" name="text-1735763621070" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Children ages?" name="children-ages" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your TOTAL BUDGET PER PERSON&amp;nbsp; for this trip?" description="Looking for the total per person. This just gives me a general starting point and can always be changed later. Only include the amount applicable to your requested quote" name="budget">&#13;
			<option label="$500-$1,500" value="$500-$1,500">$500-$1,500</option>&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference" other="true">&#13;
			<option label="Economy" value="value">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<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"/>&#13;
		<field type="header" subtype="h1" label="Travel Insurance Options"/>&#13;
		<field type="checkbox-group" required="true" label="Select one" description="The most cost efficient insurance with be the travel credit option" inline="true" name="select-one">&#13;
			<option label="Travel Credit" value="travel-credit">Travel Credit</option>&#13;
			<option label="Travel Refund" value="travel-refund">Travel Refund</option>&#13;
			<option label="I decline Insurance" value="i-decline-insurance">I decline Insurance</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Cruises(only complete if you are requesting a cruise quote)"/>&#13;
		<field type="checkbox-group" label="Would&amp;nbsp; you like gratuities included" name="would-you-like-gratuities-included">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Name and DOB(s) of additional guest(s)" name="name-and-dobs-of-additional-guests" className="form-control"/>&#13;
		<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"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>