<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Client Information"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Trip Information"/> <field type="checkbox-group" required="true" label="Where are you at in the planning process?" name="where-are-you-at-in-the-planning-process"> <option label="Just price shopping for now!" value="just-price-shopping-for-now">Just price shopping for now!</option> <option label="I'm ready to pay my $200 deposit once I find what I'm looking for!" value="im-ready-to-pay-my-200-deposit-once-i-find-what-im-looking-for">I'm ready to pay my $200 deposit once I find what I'm looking for!</option> </field> <field type="date" required="true" 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"/> <field type="date" required="true" 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"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> </field> <field type="radio-group" required="true" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true"> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option> <option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option> <option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option> <option label="$10,000+" value="10000">$10,000+</option> <option label="I'm not sure" value="im-not-sure">I'm not sure</option> </field> <field type="header" subtype="h1" label="Your Travel Party"/> <field type="text" required="true" label="How many hotel rooms do you need? If more than one, please indicate how many adults/children in each room." name="how-many-hotel-rooms-do-you-need-if-more-than-one-please-indicate-how-many-adultschildren-in-each-room" subtype="text" className="form-control"/> <field type="text" required="true" label="How many adults (age 18+) in your party? (Including yourself)" name="how-many-adults-age-18-in-your-party-including-yourself" subtype="text" className="form-control"/> <field type="text" required="true" label="How many children (ages 10-17) in your party? Please list ages." name="how-many-children-ages-1017-in-your-party-please-list-ages" subtype="text" className="form-control"/> <field type="text" required="true" label="How many children (ages 3-9) in your party? Please list ages." name="how-many-children-ages-39-in-your-party-please-list-ages" subtype="text" className="form-control"/> <field type="text" required="true" label="How many infants (ages 0-2) in your party? Please list ages." name="how-many-infants-ages-02-in-your-party-please-list-ages" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="Theme Park Tickets"/> <field type="select" label="Base Ticket Duration (One Park Per Day)" name="base-ticket-duration-one-park-per-day" className="form-control"> <option label="Please Select a Ticket Duration" value="please-select-a-ticket-duration">Please Select a Ticket Duration</option> <option label="2 Day" value="2-day">2 Day</option> <option label="3 Day" value="3-day">3 Day</option> <option label="4 Day" value="4-day">4 Day</option> <option label="5 Day" value="5-day">5 Day</option> <option label="6 Day" value="6-day">6 Day</option> <option label="7 Day" value="7-day">7 Day</option> <option label="8 Day" value="8-day">8 Day</option> <option label="9 Day" value="9-day">9 Day</option> <option label="10 Day" value="10-day">10 Day</option> <option label="Resort Only" value="resort-only">Resort Only</option> <option label="No Tickets Needed - Annual Passholder" value="no-tickets-needed-annual-passholder">No Tickets Needed - Annual Passholder</option> </field> <field type="checkbox-group" label="Optional Add-Ons" name="optional-addons"> <option label="Park Hopper " value="park-hopper-">Park Hopper </option> <option label="Park Hopper Plus (Includes Disney Water Park and Disney World Sports)" value="park-hopper-plus-includes-disney-water-park-and-disney-world-sports">Park Hopper Plus (Includes Disney Water Park and Disney World Sports)</option> <option label="Memory Maker (PhotoPass)" value="memory-maker-photopass">Memory Maker (PhotoPass)</option> <option label="Disney Travel Protection" value="disney-travel-protection">Disney Travel Protection</option> </field> <field type="header" subtype="h1" label="Accommodations Packages"/> <field type="checkbox-group" label="What type of accommodations are you interested in? Check all that apply." name="what-type-of-accommodations-are-you-interested-in-check-all-that-apply"> <option label="Walt Disney World Official Hotels Package" value="walt-disney-world-official-hotels-package">Walt Disney World Official Hotels Package</option> <option label="Swan and Dolphin Hotel Package " value="swan-and-dolphin-hotel-package-">Swan and Dolphin Hotel Package </option> <option label="Four Seasons Resort Orlando at Walt Disney World Resort Hotel Package " value="four-seasons-resort-orlando-at-walt-disney-world-resort-hotel-package-">Four Seasons Resort Orlando at Walt Disney World Resort Hotel Package </option> <option label="Gateway/Good Neighbor Hotel Package " value="gatewaygood-neighbor-hotel-package-">Gateway/Good Neighbor Hotel Package </option> </field> <field type="checkbox-group" label="Preferred Resort Category" name="preferred-resort-category"> <option label="Value Resort Hotels ($)" value="value-resort-hotels-">Value Resort Hotels ($)</option> <option label="Moderate Resort Hotels ($$)" value="moderate-resort-hotels-">Moderate Resort Hotels ($$)</option> <option label="Deluxe Resort Hotels ($$$)" value="deluxe-resort-hotels-">Deluxe Resort Hotels ($$$)</option> <option label="Deluxe Villas ($$$)" value="deluxe-villas-">Deluxe Villas ($$$)</option> <option label="Campgrounds ($$)" value="campgrounds-">Campgrounds ($$)</option> </field> <field type="checkbox-group" label="Resort Preferences" name="resort-preferences"> <option label="Monorail Access" value="monorail-access">Monorail Access</option> <option label="Skyliner Access" value="skyliner-access">Skyliner Access</option> <option label="Disney Story Rooms" value="disney-story-rooms">Disney Story Rooms</option> <option label="Suites and Villas" value="suites-and-villas">Suites and Villas</option> <option label="Club Level and Suites" value="club-level-and-suites">Club Level and Suites</option> </field> <field type="checkbox-group" label="Bedding Preferences" name="bedding-preferences" other="true"> <option label="Two Queen/Double Beds" value="two-queendouble-beds">Two Queen/Double Beds</option> <option label="One King Bed" value="one-king-bed">One King Bed</option> <option label="Sleeps 5+ guests " value="sleeps-5-guests-">Sleeps 5+ guests </option> </field> <field type="checkbox-group" label="View Preferences&nbsp;" name="view-preferences-"> <option label="Standard View (Courtyard/Parking Lot)" value="standard-view-courtyardparking-lot">Standard View (Courtyard/Parking Lot)</option> <option label="Water View (Pool/Lagoon/Lake)" value="water-view-poollagoonlake">Water View (Pool/Lagoon/Lake)</option> </field> <field type="header" subtype="h1" label="Airport Transfers"/> <field type="checkbox-group" label="Which option(s) are you interested in for airport transfers?" name="which-options-are-you-interested-in-for-airport-transfers" other="true"> <option label="Rideshare (Uber/Lyft)" value="rideshare-uberlyft">Rideshare (Uber/Lyft)</option> <option label="Shuttle Service (ex: Mears Transportation)" value="shuttle-service-ex-mears-transportation">Shuttle Service (ex: Mears Transportation)</option> <option label="Rental Car" value="rental-car">Rental Car</option> <option label="Not sure" value="not-sure">Not sure</option> </field> <field type="header" subtype="h1" label="My Disney Experience (MDE) App"/> <field type="radio-group" required="true" label="In the event you book a package, I will need to have the login and password for your Disney account in order to make your park and dining reservations for you. Alternatively, you may do it on your own (I will provide you with instructions). Please indicate your preference below." name="in-the-event-you-book-a-package-i-will-need-to-have-the-login-and-password-for-your-disney-account-in-order-to-make-your-park-and-dining-reservations-for-you-alternatively-you-may-do-it-on-your-own-i-will-provide-you-with-instructions-please-indicate-your-preference-below"> <option label="Yes, I would like you to take care of these for me, and I will send you my information." value="yes-i-would-like-you-to-take-care-of-these-for-me-and-i-will-send-you-my-information">Yes, I would like you to take care of these for me, and I will send you my information.</option> <option label="No, I prefer to book park and dining reservations myself." value="no-i-prefer-to-book-park-and-dining-reservations-myself">No, I prefer to book park and dining reservations myself.</option> <option label="Undecided at this time." value="undecided-at-this-time">Undecided at this time.</option> </field> <field type="header" subtype="h1" label="Other Information"/> <field type="text" label="Will you be celebrating anything special on your trip? (Birthday, Honeymoon, Anniversary, Family Reunion, New Job, etc)" name="will-you-be-celebrating-anything-special-on-your-trip-birthday-honeymoon-anniversary-family-reunion-new-job-etc" subtype="text" className="form-control"/> <field type="textarea" label="Do you or any members of your travel party have special needs or disabilities I need to be made aware of? Please include any needs regarding mobility and accessible rooms." name="do-you-or-any-members-of-your-travel-party-have-special-needs-or-disabilities-i-need-to-be-made-aware-of-please-include-any-needs-regarding-mobility-and-accessible-rooms" className="form-control"/> <field type="textarea" label="What else would you like me to know? Please note any additional information regarding you or members of your travel party that I may need to be made aware of in order to make your trip a successful one." description="What else would you like me to know about your travelers budget and/or travel preferences?" name="notes" className="form-control"/> <field type="paragraph" subtype="blockquote" label="Thank you for completing this form! I will get to work on your trip and will be in touch! Feel free to call/text/email me if you have questions in the meantime!"/> </fields> </form-template> </body> </html>
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