What is currently wrong with this page? I'm not sure what I'm looking at.
I see you have form element names with dashes. PHP won't like that. You should probably replace those with underscores.
I'd set the form action to the page name like: action="rates-and-availabilityx.php"
I don't see any other obvious issues. What errors are you getting? Is there a url where I can see the problem?