<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Rothe New Travel Request"/> <field type="date" required="true" label="Date of Request" name="date-of-request" className="form-control"/> <field type="radio-group" required="true" label="Estimate or Booking?" name="estimate-or-booking"> <option label="Estimate (if selected, not used for booking)" value="estimate-if-selected-not-used-for-booking">Estimate (if selected, not used for booking)</option> <option label="Booking " value="booking-">Booking </option> </field> <field type="radio-group" required="true" label="Is this a RUSH request? (All estimates/bookings will be made within 48 hours of trip approval unless marked RUSH).&nbsp;" name="is-this-a-rush-request-all-estimatesbookings-will-be-made-within-48-hours-of-trip-approval-unless-marked-rush-"> <option label="Yes, this is a RUSH request requiring estimate/booking done quickly. " value="yes-this-is-a-rush-request-requiring-estimatebooking-done-quickly-">Yes, this is a RUSH request requiring estimate/booking done quickly. </option> <option label="No, this is not a RUSH request." value="no-this-is-not-a-rush-request">No, this is not a RUSH request.</option> </field> <field type="text" label="RUSH Requests - How quickly do you need this estimate/booking?" name="rush-requests-how-quickly-do-you-need-this-estimatebooking" subtype="text" className="form-control"/> <field type="select" required="true" label="Select your program" name="select-your-program" className="form-control"> <option label="Axiom – REI – Lisandra Vazquez" value="axiom-rei-lisandra-vazquez">Axiom – REI – Lisandra Vazquez</option> <option label="CAMS – REI – Lisandra Vazquez" value="cams-rei-lisandra-vazquez">CAMS – REI – Lisandra Vazquez</option> <option label="CMC – REI – Lisandra Vazquez" value="cmc-rei-lisandra-vazquez">CMC – REI – Lisandra Vazquez</option> <option label="Corporate – RDI – Beth Carson-Romine (Indirect)" value="corporate-rdi-beth-carsonromine-indirect">Corporate – RDI – Beth Carson-Romine (Indirect)</option> <option label="Corporate – REI – Beth Carson-Romine (Indirect)" value="corporate-rei-beth-carsonromine-indirect">Corporate – REI – Beth Carson-Romine (Indirect)</option> <option label="CYPRESS – RDI – Rita Bartlett" value="cypress-rdi-rita-bartlett">CYPRESS – RDI – Rita Bartlett</option> <option label="FOMSS – REI – Sherise Campbell" value="fomss-rei-sherise-campbell">FOMSS – REI – Sherise Campbell</option> <option label="HCAL – RDI – Rita Bartlett (Indirect)" value="hcal-rdi-rita-bartlett-indirect">HCAL – RDI – Rita Bartlett (Indirect)</option> <option label="KLXS – REI – Sherise Campbell" value="klxs-rei-sherise-campbell">KLXS – REI – Sherise Campbell</option> <option label="MESC – RDI – Bill McNicol" value="mesc-rdi-bill-mcnicol">MESC – RDI – Bill McNicol</option> <option label="NOC – RDI – Tami Hubinger" value="noc-rdi-tami-hubinger">NOC – RDI – Tami Hubinger</option> <option label="NOC – REI – Tami Hubinger" value="noc-rei-tami-hubinger">NOC – REI – Tami Hubinger</option> <option label="REMIS – REI – Lisandra Vazquez" value="remis-rei-lisandra-vazquez">REMIS – REI – Lisandra Vazquez</option> <option label="ROC – REI – Tami Hubinger" value="roc-rei-tami-hubinger">ROC – REI – Tami Hubinger</option> <option label="WMCLS – REI – Beth Carson-Romine" value="wmcls-rei-beth-carsonromine">WMCLS – REI – Beth Carson-Romine</option> <option label="Other (write in program below)" value="other-write-in-program-below">Other (write in program below)</option> </field> <field type="text" label="Program Name (if you selected OTHER above)" name="program-name-if-you-selected-other-above" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Middle name (if none please say N/A)" 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" required="true" label="Cell Phone Number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Preferred Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Charge Code&nbsp; (if multiple charge codes, identify date range applicable to each; IE: if travel extension is planned)&nbsp;" name="project-number" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Services required:" name="services-required"> <option label="Air" value="air">Air</option> <option label="Accommodations " value="accommodations-">Accommodations </option> <option label="Car" value="car">Car</option> <option label="Other " value="other-">Other </option> </field> <field type="date" required="true" label="Date of departure?" 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="text" required="true" label="Departure City?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" required="true" label="Departing time requests" description="(examples: On the way there I prefer to travel in the AM or. I cannot leave until after 12pm." name="departing-time-requests" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of return?" name="date-of-return" className="form-control"/> <field type="text" required="true" label="Return time requests" description="(examples: On the way there I prefer to travel in the AM or. I cannot leave until after 12pm." name="returning-time-requests" subtype="text" className="form-control"/> <field type="text" required="true" label="Destination" 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="text" label="If you are traveling as a group, please list the names of the other employees joining the trip." name="how-many-people-will-be-sharing-the-car-rental" subtype="text" className="form-control"/> <field type="text" required="true" label="What is the area of town or location that you would like to stay near?&nbsp;" name="what-is-the-part-of-town-or-location-that-you-would-like-to-stay-near" subtype="text" className="form-control"/> <field type="select" required="true" label="Are you required to stay under per diem?" name="are-you-required-to-stay-under-per-diem" className="form-control"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" required="true" label="Will you be the primary driver of a rental car&nbsp; (Please coordinate with other travelers in your party.&nbsp; If no one answers yes to this question, no car rental will be made.)" name="will-you-be-the-primary-driver-of-a-rental-car-for-yourself-or-travel-party-please-coordinate-with-other-travelers-in-your-party-if-no-one-answers-yes-to-this-question-no-car-rental-will-be-made-"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" required="true" label="Company Travel Card (Please note you will be sent a secure CC authorization form you will need to fill out before any bookings are made with your company card)" name="travel-card"> <option label="Yes, I have a company credit card. " value="yes-i-have-a-company-credit-card-">Yes, I have a company credit card. </option> <option label="No, I do not have a company credit card. " value="no-i-do-not-have-a-company-credit-card-">No, I do not have a company credit card. </option> </field> <field type="checkbox-group" required="true" label="Are you a part of RDI or REI?" name="are-you-a-part-of-rdi-or-rei"> <option label="RDI" value="rdi">RDI</option> <option label="REI" value="rei">REI</option> </field> <field type="textarea" required="true" label="Purpose of Travel" name="purpose-of-travel" className="form-control"/> <field type="textarea" label="Other information needed for a successful trip" name="please-share-any-additional-information-that-will-help-us-book-a-great-trip-for-you" className="form-control"/> <field type="textarea" label="Justification for not using Company Preferred Airline (Southwest)" name="justification-for-not-using-company-preferred-airline-southwest" className="form-control"/> <field type="paragraph" subtype="p" label="By submitting this form you agree you have followed Rothe's Travel Policy and agree to The Giving Traveler's Terms and Conditions located at: www.thegivingtraveler.com/rothetandc"/> </fields> </form-template> </body> </html>
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