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Natalie Browning

Insider Travel Planners

<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 type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Preferred Arrival Date&amp;nbsp;" name="preferred-arrival-date-" className="form-control"/>&#13;
		<field type="date" label="Preferred departure Date&amp;nbsp;" name="preferred-departure-date-" className="form-control"/>&#13;
		<field type="select" label="Please select number of adults&amp;nbsp;" name="please-select-number-of-adults-" className="form-control">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="" value=""/>&#13;
		</field>&#13;
		<field type="select" label="Please select number of children&amp;nbsp;" name="please-select-number-of-children-" className="form-control">&#13;
			<option label="0" value="0">0</option>&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
		</field>&#13;
		<field type="text" label="Age of children" name="age-of-children" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Requested destination&amp;nbsp;" name="requested-destination-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Comments any additional helpful information" name="comments-any-additional-helpful-information" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>