Share your information with Amanda Elliott

Amanda Elliott

Passports and Footprints

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Client Information"/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" 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="h1" label="About Your Trip"/>&#13;
		<field type="textarea" label="Where would you like to go?" name="textarea-1677271653372" className="form-control"/>&#13;
		<field type="textarea" label="When would you like to depart?" name="textarea-1677271701555" className="form-control"/>&#13;
		<field type="textarea" label="When would you like to return?" name="textarea-1677271714976" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="checkbox-group-1677271737583" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city?" name="text-1677271775512" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Is this vacation to celebrate anything special?" name="textarea-1677271790550" className="form-control"/>&#13;
		<field type="textarea" label="Who will be traveling? Please list all full names (including middle) and birthdays?" name="textarea-1677271809056" className="form-control"/>&#13;
		<field type="checkbox-group" label="At what phase of planning are you in?" name="checkbox-group-1677271836849">&#13;
			<option label="I’m just beginning the planning process" value="im-just-beginning-the-planning-process">I’m just beginning the planning process</option>&#13;
			<option label="We have dates, but no other details confirmed" value="we-have-dates-but-no-other-details-confirmed">We have dates, but no other details confirmed</option>&#13;
			<option label="We have hotels and flights already booked" value="we-have-hotels-and-flights-already-booked">We have hotels and flights already booked</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What is your budget for all travelers? This just gives me a general starting point and can always be changed later." name="radio-group-1677271948068">&#13;
			<option label="$3,000 - $5,000" value="3000-5000">$3,000 - $5,000</option>&#13;
			<option label="$5,000 - $7,500" value="5000-7500">$5,000 - $7,500</option>&#13;
			<option label="$7,500 - $10,000" value="7500-10000">$7,500 - $10,000</option>&#13;
			<option label="$10,000 - $15,000" value="10000-15000">$10,000 - $15,000</option>&#13;
			<option label="$15,000 -$20,000" value="15000-20000">$15,000 -$20,000</option>&#13;
			<option label="$20,000+" value="20000">$20,000+</option>&#13;
		</field>&#13;
		<field type="textarea" label="Will you be booking any portion of your trip with points? If so, which pieces?" name="textarea-1677272033329" className="form-control"/>&#13;
		<field type="checkbox-group" label="What travel components would you like us to assist you with? Check all that apply" name="checkbox-group-1677272080945">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Transportation (Car rental, trains, etc)" value="transportation-car-rental-trains-etc">Transportation (Car rental, trains, etc)</option>&#13;
			<option label="Excursions &amp; Tours" value="excursions-tours">Excursions &amp; Tours</option>&#13;
			<option label="Trip Insurance" value="trip-insurance">Trip Insurance</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything that you “must do” or see?" name="textarea-1677272368338" className="form-control"/>&#13;
		<field type="textarea" label="Do any travelers have allergies that I should be aware of? I will do my best to accommodate!" name="textarea-1677272390079" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>