TravelJoy

Maria LaDuca

The Agency Chic - Pocono

📩 Cruise Inquiry Form – Emerald Cruises

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h2" label="Get Your Free Quote"/>&#13;
		<field type="paragraph" subtype="p" label="Please complete the form below and one of our certified cruise specialists will be in touch within 24–48 hours to help you plan the perfect luxury yacht experience."/>&#13;
		<field type="text" required="true" label="Cell number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Destination of Interest&amp;nbsp;" name="destination-of-interest-">&#13;
			<option label="Caribbean" value="caribbean">Caribbean</option>&#13;
			<option label="Mediterranean" value="mediterranean">Mediterranean</option>&#13;
			<option label="Adriatic" value="adriatic">Adriatic</option>&#13;
			<option label="Red Sea" value="red-sea">Red Sea</option>&#13;
		</field>&#13;
		<field type="text" label="Preferred Itinerary" placeholder="If Known" name="preferred-itinerary" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" description="This just gives me a general idea of when you like to return; it can be changed later." name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="If traveling with kids please indicate the ages for kids on dates of travel" description="Example Mary will be 6 on June 11  2024 etc." name="if-traveling-with-kids-please-indicate-the-ages-for-kids-on-dates-of-travel" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Additional Preferences"/>&#13;
		<field type="text" label="Are you celebrating anything special?" placeholder="(e.g. birthday, honeymoon, anniversary)" name="are-you-celebrating-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you looking to use your VALID passport?" name="are-you-looking-to-use-your-valid-passport">&#13;
			<option label="YES, my passport is ready to go!" value="yes-my-passport-is-ready-to-go">YES, my passport is ready to go!</option>&#13;
			<option label="NO,  my passport is not ready but it will be in time for this trip!" value="no-my-passport-is-not-ready-but-it-will-be-in-time-for-this-trip">NO,  my passport is not ready but it will be in time for this trip!</option>&#13;
			<option label="NO, not interested in using a passport!" value="no-not-interested-in-using-a-passport">NO, not interested in using a passport!</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="select" required="true" label="Select Your Agent" name="select-your-agent" className="form-control">&#13;
			<option label="Adrienne" value="adrienne">Adrienne</option>&#13;
			<option label="Anthony" value="anthony">Anthony</option>&#13;
			<option label="Bianca" value="bianca">Bianca</option>&#13;
			<option label="GraceAnn" value="graceann">GraceAnn</option>&#13;
			<option label="Irma" value="irma">Irma</option>&#13;
			<option label="Jessmarie" value="jessmarie">Jessmarie</option>&#13;
			<option label="Joaquina" value="joaquina">Joaquina</option>&#13;
			<option label="Kait" value="kait">Kait</option>&#13;
			<option label="Kelly" value="kelly">Kelly</option>&#13;
			<option label="Maria" value="maria">Maria</option>&#13;
			<option label="Nicole" value="nicole">Nicole</option>&#13;
			<option label="Priya" value="priya">Priya</option>&#13;
		</field>&#13;
		<field type="text" label="How did you hear about our Agency?" name="how-did-you-hear-about-our-agency" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>