Share your information with Candi Di Biase

Candi Di Biase

Devoted to Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Planning your vacation"/>&#13;
		<field type="text" required="true" label="What type of vacation are you interested in and when would you like to go?" description="Cruise  all inclusive  resort... If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Caribbean" name="destination" subtype="text" className="form-control"/>&#13;
		<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" other="true">&#13;
			<option label="$2,500 to $4,500" value="2500-to-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" 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="checkbox-group" required="true" label="Are you ready to book if I find something that meets your needs?" name="are-you-ready-to-book-if-i-find-something-that-meets-your-needs">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="Just looking at options" value="just-looking-at-options">Just looking at options</option>&#13;
			<option label="Not ready" value="not-ready">Not ready</option>&#13;
		</field>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>