Share your information with Tonya Bullock

Tonya Bullock

Crossroads Travel Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h3" label="Client Intake Form&amp;nbsp;"/>&#13;
		<field type="paragraph" subtype="p" label="Please complete this form so I can gather the details needed to thoughtfully curate a trip tailored to your travel style, preferences, and priorities."/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field required="true"  type="text" label="Email" 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 on your trip?" name="text-1767038215055" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" name="date-1767038256566" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" name="date-1767038278027" className="form-control"/>&#13;
		<field type="select" label="Are your dates flexible?" name="select-1767038313742" className="form-control">&#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-1767038373744" subtype="text" className="form-control"/>&#13;
		<field type="text" label="How many travelers?&amp;nbsp;" name="text-1767038399066" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="What is your budget for all travelers?&amp;nbsp; ( excluding flights)" name="checkbox-group-1767038434010">&#13;
			<option label="$1,500 to $2,500" value="1500-to-2500">$1,500 to $2,500</option>&#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-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-to-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What best describes your hotel preference?" name="checkbox-group-1767060637080">&#13;
			<option label="Economy" value="economy">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;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Hotel budget per night&amp;nbsp;" name="checkbox-group-1767060769224">&#13;
			<option label="$300-$400" value="300400">$300-$400</option>&#13;
			<option label="$400-$500" value="400500">$400-$500</option>&#13;
			<option label="$500-$650" value="500650">$500-$650</option>&#13;
			<option label="$650-$800" value="650800">$650-$800</option>&#13;
			<option label="$800-$1,000" value="8001000">$800-$1,000</option>&#13;
			<option label="$1,000-$1,2000" value="100012000">$1,000-$1,2000</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" name="checkbox-group-1767060936347">&#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="Off the Beaten Path" value="off-the-beaten-path">Off the Beaten Path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local Culture" value="local-culture">Local Culture</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Food and Wine" value="food-and-wine">Food and Wine</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" name="checkbox-group-1767061084565">&#13;
			<option label="Beach and water" value="beach-and-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure-activities">Adventure activities</option>&#13;
			<option label="Golf " value="golf-">Golf </option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and Theater" value="arts-and-theater">Arts and Theater</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="text-1767061227741" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?&amp;nbsp; Additional Information" name="textarea-1767061298212" className="form-control"/>&#13;
		<field type="checkbox-group" label="How did you hear about Crossroads Travel Agency?" name="checkbox-group-1767061322968">&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="TikTok" value="tiktok">TikTok</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
			<option label="Fora Profile" value="fora-profile">Fora Profile</option>&#13;
			<option label="Crossroads Travel Agency Website" value="crossroads-travel-agency-website">Crossroads Travel Agency Website</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>