Share your information with Bruce Powell

Bruce Powell

BWP Travel, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#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="Email Address" 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="text" label="Where would you like to go?" placeholder="If you’re not sure  please list a few destinations you’re considering" name="destination" subtype="text" className="form-control"/>&#13;
		<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"/>&#13;
		<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"/>&#13;
		<field type="radio-group" label="Are your dates flexible?" name="are-your-dates-flexible" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you need airfare pricing and options to be included in this quote?" name="radio-group-1769390834484">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1769315985291" rule="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"/>&#13;
		<field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="radio-group" required="true" label="Estimated Number of Travelers" inline="true" name="estimated-number-of-travelers">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9" value="9">9</option>&#13;
			<option label="10+" value="10">10+</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1769316209805" rule="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"/>&#13;
		<field type="radio-group" label="Are any of the travelers children? (Less than 18 years of age at the time of travel)" name="are-any-of-the-travelers-under-children-less-than-18-years-of-age-at-the-time-of-travel">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="conditionalLogic" label="Conditional Logic" name="conditionalLogic-1769391082828" rule="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"/>&#13;
		<field type="text" label="Please indicate how many travelers will be under 18 and their ages at the time of travel." description="e.g. 2 Children  Ages 5 &amp;amp; 7 at the time of travel" name="please-indicate-how-many-travelers-will-be-under-18-and-their-ages-at-the-time-of-travel" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your estimated budget for this trip? (Including Air Fare if applicable)" name="what-is-your-estimated-budget-for-this-trip-including-air-fare-if-applicable" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Is your estimated budget noted above, per person or total for everyone?&amp;nbsp;" name="is-your-estimated-budget-noted-above-per-person-or-total-for-everyone-">&#13;
			<option label="Per Person" value="per-person">Per Person</option>&#13;
			<option label="Total for all Passengers" value="total-for-all-passengers">Total for all Passengers</option>&#13;
			<option label="Not Applicable (Solo Traveler)" value="not-applicable-solo-traveler">Not Applicable (Solo Traveler)</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Which best describes your travel style?" name="hotel-preference" other="true">&#13;
			<option label="Luxury - 5 Stars " value="luxury-5-stars-">Luxury - 5 Stars </option>&#13;
			<option label="Upscale - 4 Stars " value="upscale-4-stars-">Upscale - 4 Stars </option>&#13;
			<option label="Moderate - 3 Stars " value="moderate-3-stars-">Moderate - 3 Stars </option>&#13;
			<option label="Boutique (Smaller More Intimate Hotels)" value="boutique-smaller-more-intimate-hotels">Boutique (Smaller More Intimate Hotels)</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your most preferred accommodation type?" name="what-is-your-most-preferred-accommodation-type">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Resort" value="resort">Resort</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Private Home / Condo / Apartment" value="private-home-condo-apartment">Private Home / Condo / Apartment</option>&#13;
			<option label="Staffed Villa" value="staffed-villa">Staffed Villa</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Are you open to any additional accommodation types?" name="what-type-of-accommodations-are-you-interested-in" other="true">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Resort" value="resort">Resort</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Private Home / Apartment / Condo" value="private-home-apartment-condo">Private Home / Apartment / Condo</option>&#13;
			<option label="Staffed Villa" value="staffed-villa">Staffed Villa</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#13;
		<field type="select" label="&amp;nbsp;How Many Hotel Rooms, Cruise Cabins , or Bedrooms Do You Need?" name="-how-many-rooms-cabins-or-bedrooms-do-you-need" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5" value="5">5</option>&#13;
			<option label="6" value="6">6</option>&#13;
			<option label="7" value="7">7</option>&#13;
			<option label="8" value="8">8</option>&#13;
			<option label="9" value="9">9</option>&#13;
			<option label="10 or More" value="10-or-more">10 or More</option>&#13;
		</field>&#13;
		<field type="text" label="Are there any specific room amenities or features you’re interested in?" placeholder="i.e. Butler Service  Swim-Up  Suite etc." name="room-upgrades-are-there-are-any-specific-amenities-or-features-you-want" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Room Bedding Preference" name="bedding-preference" other="true">&#13;
			<option label="One Bed " value="one-bed-">One Bed </option>&#13;
			<option label="Two Beds " value="two-beds-">Two Beds </option>&#13;
			<option label="Mixed (Multiple Rooms)" value="mixed-multiple-rooms">Mixed (Multiple Rooms)</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="Party" value="party">Party</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="LGBT Friendly" value="lgbt-friendly">LGBT Friendly</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Flight Cabin/Class Preference&amp;nbsp;" name="flight-cabinclass-preference-" className="field-hidden">&#13;
			<option label="First/Business Class" value="firstbusiness-class">First/Business Class</option>&#13;
			<option label="Premium Economy/Economy Plus" value="premium-economyeconomy-plus">Premium Economy/Economy Plus</option>&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Interested in Comparing Prices for All Cabins" value="interested-in-comparing-prices-for-all-cabins">Interested in Comparing Prices for All Cabins</option>&#13;
		</field>&#13;
		<field type="text" label="Flights:&amp;nbsp; Please include any additional air travel preferences.&amp;nbsp;" name="air-travel-details-please-include-any-other-details-regarding-your-air-travel-preferences-if-applicable" subtype="text" className="form-control field-hidden"/>&#13;
		<field type="text" label="Are you celebrating any special occasion during this trip?" name="are-you-celebrating-any-special-occasion-during-this-trip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are there any specific activities that you are interested in?" name="are-there-any-specific-activities-that-you-are-interested-in" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Are there any special accommodations or accessibility needs we should be aware of?" placeholder="ex: Ground Floor ADA accessible room  wheelchair at airport etc." name="please-advise-us-if-you-require-any-special-accommodation" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="How Soon Are You Looking to Book?" name="how-soon-are-you-looking-to-book" other="true">&#13;
			<option label="Immediately" value="immediately">Immediately</option>&#13;
			<option label="Within the Next Few Weeks" value="within-the-next-few-weeks">Within the Next Few Weeks</option>&#13;
			<option label="Still Deciding / Unsure" value="still-deciding-unsure">Still Deciding / Unsure</option>&#13;
		</field>&#13;
		<field type="text" label="May we ask; how did you hear about us?" description="How did you find BWP Travel?" name="may-we-ask-how-did-you-hear-about-us" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like us to know?" description="What else would you like us to know about your travelers  budget and/or travel preferences?" placeholder="What else would you like us to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>