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?


