Share your information with Jen Bott

Jen Bott

The Magic Vacay

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Which destination are you interested in?" name="which-destination">&#13;
			<option label="Disneyland Resort" value="disneyland-resort">Disneyland Resort</option>&#13;
			<option label="Disney World" value="disney-world">Disney World</option>&#13;
			<option label="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Disney Cruise" value="disney-cruise">Disney Cruise</option>&#13;
			<option label="Disneyland Paris" value="disneyland-paris">Disneyland Paris</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="Check in date?" description="The more exact your dates are  the more accurate the quote pricing will be." name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="Check out date?" 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="radio-group" 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" className="radio-group">&#13;
			<option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option>&#13;
			<option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Total number of travelers." name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ages of kids at time of travel? Required for quote accuracy." placeholder="Please include babies too" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Need more than 1 room? Please specify how many rooms and number of adults/kids (with ages of kids) in each room." name="textarea-1779835177557" rows="4" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="How many theme park days?" name="hotel-preference" other="true">&#13;
			<option label="2" value="Value">2</option>&#13;
			<option label="3" value="Value">3</option>&#13;
			<option label="4" value="">4</option>&#13;
			<option label="5" value="">5</option>&#13;
			<option label="No tickets needed" value="no-tickets-needed">No tickets needed</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Add ons (additional fees apply)" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="add Park Hopping" value="add-park-hopping">add Park Hopping</option>&#13;
			<option label="add Lightning Lane Multipass (Disneyland Resort only)" value="add-lightning-lane-multipass-disneyland-resort-only">add Lightning Lane Multipass (Disneyland Resort only)</option>&#13;
			<option label="Memory Maker (Disney World only)" value="memory-maker-disney-world-only">Memory Maker (Disney World only)</option>&#13;
			<option label="Dining Plan (Disney World only)" value="dining-plan-disney-world-only">Dining Plan (Disney World only)</option>&#13;
			<option label="VIP Tours" value="vip-tours">VIP Tours</option>&#13;
			<option label="Event Tickets" value="event-tickets">Event Tickets</option>&#13;
		</field>&#13;
		<field type="select" label="Would you like to receive my Newsletters with tips and promos?" description="It will not be more than twice a month." name="would-you-like-to-receive-my-newsletters-with-tips-and-promos" className="form-control">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="I&#39;m so excited to get planning! Is there anything else I should know about you or your traveling party? (special needs, must do&#39;s, celebrations, questions, cabin type preference, hotel preference, etc). Also let me know if you are a Disney Visa cardholder, Disney+ Subscriber, or CA/FL resident for possible discounts." name="notes" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>