Share your information with Anthony Pagan

Anthony Pagan

Tailored Destination

<html>
  <body>
    <form-template>
  <fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>
    <field label="Questions for your trip" subtype="h2" type="header"/>
    <field description="If you&#39;re not sure, just give me a few destinations you&#39;re considering." label="Where would you like to go?" name="destination" placeholder="ex: Tahiti" subtype="text" type="text" className="form-control"/>
    <field description="This just gives me a general idea of when you like to go; it can be changed later." label="When would you like to depart?" name="starting-at" type="date" className="form-control"/>
    <field description="This just gives me a general idea of when you like to return; it can be changed later." label="When would you like to return?" name="ending-at" type="date" className="form-control"/>
    <field label="Are your dates flexible?" name="dates-flexible" type="checkbox-group"><option label="Yes" value="yes">Yes</option></field>
    <field description="Where will you be flying from?" label="What is your departure city?" name="departure-city" subtype="text" type="text" className="form-control"/>
    <field label="How many travelers?" name="number-of-travelers" type="text" className="form-control"/>
    <field description="This just gives me a general starting point and can always be changed later." label="What is your budget for all travelers?" name="budget" type="radio-group">
      <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 label="What best describes your hotel preference?" name="hotel-preference" other="true" type="radio-group">
      <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>
    </field>
    <field description="Check all that apply." label="What kind of vibe are you looking for?" name="vibe-preference" other="true" type="checkbox-group">
      <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 description="Check all that apply" label="What activities are you interested in?" name="activity-preferences" other="true" type="checkbox-group">
      <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>
    </field>
    <field label="Anything you absolutely must do or see?" name="must-dos" subtype="text" type="text" className="form-control"/>
    <field description="What else would you like me to know about your travelers, budget and/or travel preferences?" label="What else would you like me to know?" name="notes" subtype="textarea" type="textarea" className="form-control"/>
  </fields>
</form-template>
  </body>
</html>