Share your information with Stephany Hennings

Stephany Hennings

Travelessence

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="radio-group" required="true" label="Type of Travelessence customer" inline="true" name="type-of-travelessence-customer">&#13;
			<option label="New Customer" value="new-customer">New Customer</option>&#13;
			<option label="Returning Customer" value="returning-customer">Returning Customer</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Primary Traveler 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" required="true" label="Active Email Address" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" description="What is the best phone number to reach you while traveling?" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Tell us your initial trip idea"/>&#13;
		<field type="radio-group" required="true" label="Which kind of trip do you have in mind?" inline="true" name="what-kind-of-trip-do-you-have-in-mind">&#13;
			<option label="Land Travel" value="land-travel">Land Travel</option>&#13;
			<option label="Sea Travel (Cruise)" value="sea-travel-cruise">Sea Travel (Cruise)</option>&#13;
			<option label="Both" value="both">Both</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Where do you want to go?&amp;nbsp; This can be a tropical destination in the Caribbean or perhaps Costa Rica? Or maybe you want to go on a cruise with Seabourn or an AmaWaterways river cruise." name="where-do-you-want-to-go-dream-big-this-is-your-bucket-list" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="When are you planning to travel?" placeholder="mm/dd/yyyy - mm/dd/yyyy" name="when-do-you-want-to-go" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many travelers in your party?&amp;nbsp;" name="how-many-travelers-in-your-party-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are you celebrating a special occasion?" placeholder="Ex: Birthday  Honeymoon  or just because" name="are-you-celebrating-a-special-occasion" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>