<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Tell us about your upcoming trip!"/> <field type="paragraph" subtype="p" label="LUXE Worldwide Travel can help you plan your next getaway! We plan ultra-luxury Experiences for our clients. No matter what your budget is, you are always a VIP! Complete this form below and one of our VIP Specialists will get back to you shortly with next steps. You can also schedule a complimentary chat after completing this questionnaire.&nbsp;"/> <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="Mobile Number" description="Kindly provide your Mobile Number so that we can reach out to you." name="phone-number" subtype="text" className="form-control"/> <field required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="date" label="Date of Birth" name="birthday" className="form-control"/> <field type="select" required="true" label="Are you the traveler or are you planning this trip for someone else?" name="are-you-the-traveler-or-are-you-planning-this-trip-for-someone-else" className="form-control"> <option label="YES - I'm the traveler" value="yes-im-the-traveler">YES - I'm the traveler</option> <option label="NO - I'm planning for someone else; send me all communications for the trip. " value="no-im-planning-for-someone-else-send-me-all-communications-for-the-trip-">NO - I'm planning for someone else; send me all communications for the trip. </option> </field> <field type="text" label="If you &nbsp;aren't the traveler, please provide the name of the primary traveler here and his/her/their contact details below.&nbsp;" name="if-you-arent-the-traveler-please-provide-the-name-of-the-primary-traveler-here-and-hisher-contact-details-below-" subtype="text" 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="select" required="true" label="Does the Traveler have a valid passport?&nbsp;" name="does-the-traveler-have-a-valid-passport-" className="form-control"> <option label="YES - Traveler's passport is valid for at least 6 months after the return date of the trip. " value="yes-travelers-passport-is-valid-for-at-least-6-months-after-the-return-date-of-the-trip-">YES - Traveler's passport is valid for at least 6 months after the return date of the trip. </option> <option label="NO - Traveler doesn't have a passport. Willing to apply >90+ days before travel" value="no-traveler-doesnt-have-a-passport-willing-to-apply-90-days-before-travel">NO - Traveler doesn't have a passport. Willing to apply >90+ days before travel</option> <option label="N/A - I'm traveling within (or cruising from) USA. Only need valid Government ID with certified copy of US birth certificate. " value="na-im-traveling-within-or-cruising-from-usa-only-need-valid-government-id-with-certified-copy-of-us-birth-certificate-">N/A - I'm traveling within (or cruising from) USA. Only need valid Government ID with certified copy of US birth certificate. </option> </field> <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." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/> <field type="text" required="true" label="What is your departure city or preferred airport?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="date" 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" 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="text" label="What is your flexibility?" name="what-is-your-flexibility" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Are you a First Responder, Healthcare Professional, Law Enforcement Officer, Active Duty or Veteran?" name="are-you-a-first-responder-healthcare-professional-law-enforcement-officer-active-duty-or-veteran"> <option label="No I am not. " value="no-i-am-not-">No I am not. </option> <option label="First Responder" value="first-responder">First Responder</option> <option label="Healthcare Professional" value="healthcare-professional">Healthcare Professional</option> <option label="Law Enforcement" value="law-enforcement">Law Enforcement</option> <option label="Veteran / Active Duty" value="veteran-active-duty">Veteran / Active Duty</option> </field> <field type="textarea" label="Do you have any special requests for air or hotel?" description="Indicate here if you are departing or arriving into different cities or need air with different dates from specific airports." name="special-air-requests" className="form-control"/> <field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="How will everyone pay for their trip?&nbsp;" description="This helps us personalize your Proposal and Invoices." name="payment-options"> <option label="Paying with the same method - single invoice" value="paying-single-invoice">Paying with the same method - single invoice</option> <option label="Paying individually & needs own invoice" value="paying-individually">Paying individually & needs own invoice</option> </field> <field type="radio-group" required="true" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="0-$1,500 (least expensive as possible)" value="least-expensive-under-1500">0-$1,500 (least expensive as possible)</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="How soon do you plan to book your trip?" name="how-soon-do-you-plan-to-book-your-trip"> <option label="UNSURE - Still shopping around for pricing comparisons." value="unsure-still-shopping-around-for-pricing-comparisons">UNSURE - Still shopping around for pricing comparisons.</option> <option label="IMMEDIATELY - Ready to book and pay in 0-14 days once I find the right package. " value="immediately-ready-to-book-and-pay-in-014-days-once-i-find-the-right-package-">IMMEDIATELY - Ready to book and pay in 0-14 days once I find the right package. </option> <option label="SOON - Book in 15-30 days; Considering my options; I understand prices are subject to change and based on availability. Any quote I get will need to be repriced." value="soon-book-in-1530-days-considering-my-options-i-understand-prices-are-subject-to-change-and-based-on-availability-any-quote-i-get-will-need-to-be-repriced">SOON - Book in 15-30 days; Considering my options; I understand prices are subject to change and based on availability. Any quote I get will need to be repriced.</option> <option label="NOT NOW - Ready to pay in >30-60 days; I understand prices are subject to change and based on availability. Any quote I get will need to be repriced." value="not-now-ready-to-pay-in-3060-days-i-understand-prices-are-subject-to-change-and-based-on-availability-any-quote-i-get-will-need-to-be-repriced">NOT NOW - Ready to pay in >30-60 days; I understand prices are subject to change and based on availability. Any quote I get will need to be repriced.</option> </field> <field type="radio-group" required="true" label="What best describes your accommodation preference?" name="hotel-preference" other="true"> <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> <option label="All-Inclusive" value="alli-nclusive">All-Inclusive</option> <option label="Villa / Air BnB" value="villa-air-bnb">Villa / Air BnB</option> <option label="Family Suites w/ Connecting Rooms" value="family-suites-connecting-rooms">Family Suites w/ Connecting Rooms</option> <option label="Special Needs Accomodations" value="special-needs-accomodations">Special Needs Accomodations</option> </field> <field type="textarea" required="true" label="Do you have any dietary restrictions or food allergies? Indicate "no" if not applicable." name="do-you-have-any-dietary-restrictions-or-food-allergies-indicate-no-if-not-applicable" className="form-control"/> <field type="textarea" required="true" label="Do you have any medical conditions or undergoing any treatment that we need to be aware of? Do you require a wheelchair, scooter or other accessible equipment in your accommodations ? Indicate "no" if not applicable." name="do-you-have-any-medical-conditions-or-undergoing-any-treatment-that-we-need-to-be-aware-of-do-you-require-a-wheelchair-scooter-or-other-accessible-equipment-in-your-accommodations-indicate-no-if-not-applicable" className="form-control"/> <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> </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> <option label="Corporate / Meeting" value="corporate-meeting">Corporate / Meeting</option> <option label="Incentive Trip" value="incentive-trip">Incentive Trip</option> <option label="Conference / Seminar at Sea" value="conference-seminar-at-sea">Conference / Seminar at Sea</option> <option label="Family Reunion" value="family-reunion">Family Reunion</option> <option label="Special Birthday / Anniversary" value="special-birthday-anniversary">Special Birthday / Anniversary</option> <option label="Destination Wedding / Honeymoon" value="destination-wedding-honeymoon">Destination Wedding / Honeymoon</option> <option label="Ocean / River Cruise" value="ocean-river-cruise">Ocean / River Cruise</option> <option label="Concert / Comedy / Music Festival" value="concert-comedy-music-festival">Concert / Comedy / Music Festival</option> </field> <field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/> <field type="textarea" required="true" label="Anything else you think we should know? (Special requests, traveling with a group, comments, notes, etc.)" description="What else would you like us to know about your travelers budget and/or travel preferences?" placeholder="Have you looked online and gotten any price quotes already that you need us to match or beat? What other agencies have you spoken to about this trip? Is this a bucket list experience for you?" name="notes" className="form-control"/> <field type="header" subtype="h1" label="Special Events"/> <field type="radio-group" required="true" label="Would you like us to plan a special event for your traveler(s) before, during or after the trip?" name="would-you-like-us-to-plan-a-special-event-for-your-travelers-before-during-or-after-the-trip"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Maybe / Not Sure Yet" value="maybe-not-sure-yet">Maybe / Not Sure Yet</option> </field> <field type="header" subtype="h1" label="Mailing Address and Travel Insurance"/> <field type="radio-group" required="true" label="LUXE Worldwide Travel always recommends travel insurance in case of emergency, trip delay or COVID19 challenges to provide peace of mind should you need to cancel or reschedule. Kindly supply your mailing address below so we can explore options available for your upcoming trip. &nbsp;We also need your address for all of your travel electronic documents, airline, hotel and cruise bookings. Kindly complete below.&nbsp;" name="luxe-worldwide-travel-always-recommends-travel-insurance-in-case-of-emergency-trip-delay-or-covid19-challenges-to-provide-peace-of-mind-should-you-need-to-cancel-or-reschedule-kindly-supply-your-mailing-address-below-so-we-can-explore-options-available-for-your-upcoming-trip-we-also-need-your-address-for-all-of-your-travel-electronic-documents-airline-hotel-and-cruise-bookings-kindly-complete-below-"> <option label="Yes - please include travel insurance in my Trip Proposal / Quote" value="Yes">Yes - please include travel insurance in my Trip Proposal / Quote</option> <option label="No - I DECLINE travel insurance. I understand in the event of emergency / cancellation I will be responsible for 100% of my trip cost. I understand I am responsible for 100% of my medical expenses." value="no-i-decline-travel-insurance-i-understand-in-the-event-of-emergency-cancellation-i-will-be-responsible-for-100-of-my-trip-cost-i-understand-i-am-responsible-for-100-of-my-medical-expenses">No - I DECLINE travel insurance. I understand in the event of emergency / cancellation I will be responsible for 100% of my trip cost. I understand I am responsible for 100% of my medical expenses.</option> <option label="Maybe - I plan to use my existing coverage. Please advise of my options. " value="Maybe">Maybe - I plan to use my existing coverage. Please advise of my options. </option> </field> <field type="text" required="true" label="Address Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Address Line 2 / PO Box (if any)" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip / Postal Code" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Customized Travel Design and Trip Planning"/> <field type="select" required="true" label="I understand there is a non-refundable Travel Design Service and Plan to Go Fee collected prior any services being performed including custom itineraries. This will be discussed in detail during our Complimentary Consultation. Please indicate that you understand by selecting Yes below. If you do NOT accept, we will not proceed with processing your trip request. We will email you an invoice for your Plan to Go Custom Trip Plan as soon as we complete your consultation. Kindly confirm you will make that payment immediately if you want LUXE to move forward with researching your trip." name="i-understand-there-is-a-nonrefundable-travel-design-service-plan-to-go-fee-collected-prior-any-services-being-performed-this-will-be-discussed-in-detail-during-our-complimentary-consultation-please-indicate-that-you-understand-by-selecting-yes-below-if-you-do-not-accept-we-will-not-proceed-with-processing-your-trip-request" className="form-control"> <option label="YES - I understand" value="yes-i-understand">YES - I understand</option> <option label="NO" value="no">NO</option> </field> </fields> </form-template> </body> </html>
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