Share your information with Rahul Agarwal

Rahul Agarwal

Travelmation

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Let me know who you are!"/>&#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="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Trip Details"/>&#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="text" required="true" label="When would you like to go?" name="when-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers?" description="5 adults  2 children, etc." placeholder="5 adults  2 children, etc." name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are the ages of the travelers?" placeholder="35  26, 72, 6, etc." name="what-are-the-ages-of-the-travelers" subtype="text" className="form-control"/>&#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="textarea" label="What are some &quot;must haves&quot; on this trip? What is most important to you?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="text" label="How did you hear about me?" name="how-did-you-hear-about-me" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="By submitting this quote, you are giving me permission to text the phone number above with relevant information concerning your request and add your email to my email list.&amp;nbsp;" name="permission-to-text">&#13;
			<option label="Yes, I understand. Please text!" value="yes-i-understand-please-text">Yes, I understand. Please text!</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>