Wishah World Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Preferred Contact Method" name="preferred-contact-method">&#13;
			<option label="Call" value="call">Call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Any" value="any">Any</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Travel Details"/>&#13;
		<field type="text" label="Destination(s)" name="destinations" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Departure Date" name="departure-date" className="form-control"/>&#13;
		<field type="date" label="Return Date" name="return-date" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Type of Trip" name="type-of-trip" other="true">&#13;
			<option label="Couples" value="couples">Couples</option>&#13;
			<option label="Family" value="family">Family</option>&#13;
			<option label="Solo" value="solo">Solo</option>&#13;
			<option label="Group" value="group">Group</option>&#13;
		</field>&#13;
		<field type="text" label="Are you celebrating a special occasion?" name="are-you-celebrating-a-special-occasion" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Tell me about your trip. What are you looking for?" name="tell-me-about-your-trip-what-are-you-looking-for" className="form-control"/>&#13;
		<field type="text" label="Will you need help with booking flights? If so, please indicate your home airport." name="will-you-need-help-with-booking-flights-if-so-please-indicate-your-home-airport" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your total budget for this trip? (including flights, if applicable)" name="what-is-your-total-budget-for-this-trip-including-flights-if-applicable" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers will there be?" name="how-many-travelers-will-there-be" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please list full names and DOBs for all travelers." name="please-list-full-names-and-dobs-for-all-travelers" className="form-control"/>&#13;
		<field type="textarea" label="Additional Information" name="additional-information" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Wishah World Travel Fees"/>&#13;
		<field type="paragraph" subtype="p" label="ECONOMY | Includes simple flight + accommodation requests. [$50 per person]"/>&#13;
		<field type="paragraph" subtype="p" label="BUSINESS | Includes flight + accommodation + activities + transportation requests. [$100 per person]"/>&#13;
		<field type="paragraph" subtype="p" label="FIRST CLASS | Includes flight + accommodation + activities + transportation + dining + shopping + more. [$150 per person]"/>&#13;
		<field type="paragraph" subtype="p" label="FLIGHT ONLY | U.S. Domestic [$50 per ticket] // International [$100 per ticket]"/>&#13;
		<field type="radio-group" label="What Class of Service can we provide you?" name="what-class-of-service-can-we-provide-you">&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Business" value="business">Business</option>&#13;
			<option label="First Class" value="first-class">First Class</option>&#13;
			<option label="Flight Only" value="flight-only">Flight Only</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>