<div class="row">
    <div class="col-md-4">
        <p>
            * Number of Traveler(s)
            [number* no-Travelers min:1 max:99]
        </p>
    </div>
    <div class="col-md-4">
        <p>
            Name(s)
            [text onsinger-text-40 class:travelers_name placeholder "e.g. Max, David, Matt" ]
        </p>
    </div>
    <div class="col-md-4">
         <p>Surname(s)
            [text Surname-text-40 placeholder "e.g. Cutt, Gallardo, Cutt"]
        </p>
    </div>
    <div class="col-md-4">
        <p>
            Ship Name
            [text ship-name id:select2_ship_name size:60]
        </p>
    </div>
    <div class="col-md-4">
        <p>
            Ship #
            [text ship-number id:ship_no_val]
        </p>
    </div>
    <div class="col-md-4">
       <p>* Ship Location
            [select* ship-location class:ship_location]
        </p>
    </div>
    <div class="col-md-6">
        <p>* Date
            [date* date-983 id:reservation_date]
        </p>
    </div>
    <div class="col-md-6">
        <p class="input-group clockpicker" data-placement="bottom" data-align="top" data-autoclose="true">* Time
            [text* journey-text-488 class:form-control]
        </p>
    </div>
    <div class="col-md-12">
        <p>* Cell Phone
            [tel* cellphone-tel-509]<span class="smalltext">(If SeaFarer phone number is not available then input your phone number and deselect Apple Crew tracking at bottom of page)</span>
        </p>
    </div>
    <div class="col-md-12">
        <h4>SHUTTLE OFF-SIGNER DESTINATION
        </h4>
    </div>
    <div class="col-md-6">
        <p>Hotel
            [text Hotel-text-550]
        </p>
    </div>
    <div class="col-md-5">
        <p>ACTS Lounge
            [text Lounge-text-550]
        </p>
    </div>
    <div class="col-md-6">
        <p> PickUp Date
            [date* PickUp-date-8734 id:reservation_date]
        </p>
    </div>
    <div class="col-md-6">
        <p class=" clockpicker" data-placement="bottom" data-align="top" data-autoclose="true">PickUp Time  <span class="smalltext">(Please include the three hour requirement for int’l flights)</span>
            [text* PickUpTime-text-8788 class:form-control ]
        </p>
    </div>
    <div class="col-md-4">
        <p>* Airlines Name
            [text* Airlines-text-551]
        </p>
    </div>
    <div class="col-md-4">
        <p>* Flight #
            [text flight-text-552]
        </p>
    </div>
    <div class="col-md-4">
        <p>Air Port (SAV)
            [text Air-text-550]
        </p>
    </div>
    <div class="col-md-6">
        <p>* Date
            [date* flight-date-983 id:reservation_date]
        </p>
    </div>
    <div class="col-md-6">
        <p class=" clockpicker" data-placement="bottom" data-align="top" data-autoclose="true">* Time
            [text* flight-journey-text-488 class:form-control]
        </p>
    </div>
    
    <div class="col-md-4" style="text-align: center;">
        <p>CBP Service
            [radio radio-485 default:2 "Yes" "No"]
        </p>
    </div>
    <div class="col-md-4" style="text-align: center;">
        <p>Gate & TWIC Service
            [radio radio-4855 default:2 "Yes" "No"]
        </p>
    </div>
    <div class="col-md-4" style="text-align: center;">
        <p>Boarding Pass Service
            [radio radio-48555 default:2 "Yes" "No"]
        </p>
    </div>
    
    <div class="col-md-12">
        <p>* I want Agent Updates and Tracking, during the time of travel.
            [radio sradio-9797 default:1 "Yes" "No"]
        </p>
    </div>
    <div class="col-md-4">
        <div class="single-contact-field">
            [hidden total_price class:total_price ]
            [submit id:submit class:gauto-theme-btn "Submit"]
        </div>
    </div>
    <div class="col-md-12">
        <p><span class="smalltext">* The proprietary tracking software used on this site is experimental and still underdevelopment; therefore the company nor any of its affiliates, can make any guarantees regarding it’s reliability or accuracy at this time.</span></p>
    </div>
</div>