Share your information with Jayvani House

Jayvani House

Out of the House Travel

<html>
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    <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>&#13;
		<field type="header" subtype="h2" label="OTH Cruise Inquiry"/>&#13;
		<field type="header" subtype="h1" label="Contact Info"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Method of Contact" name="checkbox-group-1781500031840">&#13;
			<option label="Phone call" value="phone-call">Phone call</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Voice note" value="voice-note">Voice note</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="How did you hear about us?" name="checkbox-group-1781580572009">&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
			<option label="Social Media " value="social-media-">Social Media </option>&#13;
			<option label="Advertising" value="advertising">Advertising</option>&#13;
			<option label="Event" value="event">Event</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Trip Info"/>&#13;
		<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"/>&#13;
		<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"/>&#13;
		<field type="text" required="true" label="How many travelers? (including yourself)" name="text-1769439695122" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Preferred Destinations" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many staterooms? (including yours)" name="text-1782831026147" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Stateroom Preference(s)" description="You can select more than 1 option if you&#39;re not sure!" name="checkbox-group-1782830231638">&#13;
			<option label="Interior" value="interior">Interior</option>&#13;
			<option label="Ocean View (Window)" value="ocean-view-window">Ocean View (Window)</option>&#13;
			<option label="Ocean View Balcony" value="ocean-view-balcony">Ocean View Balcony</option>&#13;
			<option label="Interior Balcony" value="interior-balcony">Interior Balcony</option>&#13;
			<option label="Suite " value="suite-">Suite </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Preferred Cruise Line(s)" description="You can select more than 1 option if you&#39;re not sure!" name="checkbox-group-1782831068298">&#13;
			<option label="Royal Caribbean International" value="royal-caribbean-international">Royal Caribbean International</option>&#13;
			<option label="Carnival Cruise Line" value="carnival-cruise-line">Carnival Cruise Line</option>&#13;
			<option label="MSC Cruises" value="msc-cruises">MSC Cruises</option>&#13;
			<option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Celebrity Cruises" value="celebrity-cruises">Celebrity Cruises</option>&#13;
			<option label="Princess Cruises" value="princess-cruises">Princess Cruises</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Preferred Departure Port(s)" description="You can select more than 1 option if you&#39;re not sure!" name="checkbox-group-1782830626186" other="true">&#13;
			<option label="Miami, FL" value="miami-fl">Miami, FL</option>&#13;
			<option label="Port Canaveral (Orlando), FL" value="port-canaveral-orlando-fl">Port Canaveral (Orlando), FL</option>&#13;
			<option label="Ft. Lauderdale, FL" value="ft-lauderdale-fl">Ft. Lauderdale, FL</option>&#13;
			<option label="Tampa, FL" value="tampa-fl">Tampa, FL</option>&#13;
			<option label="Galveston, TX" value="galveston-tx">Galveston, TX</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Select pre and post needs for your trip" description="We recommend traveling to the departure destination 1-2 days before embarkation to avoid trip interruptions like delayed or canceled flights. This has been proven to alleviate day-of stress  rushing and the possibility of missing your cruise!" name="checkbox-group-1782828952175" other="true">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Flight" value="flight">Flight</option>&#13;
			<option label="Trip Protection" value="trip-protection">Trip Protection</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Info"/>&#13;
		<field type="radio-group" required="true" label="Do you have a passport?" description="We recommend acquiring a passport book for your trip. A passport card  REAL ID or birth certificate cannot be used for international air travel in the event of an emergency. If you don&#39;t have one, we will help you get one!" name="radio-group-1769440184353">&#13;
			<option label="Yes, current 6 months before and after travel" value="yes-current-6-months-before-and-after-travel">Yes, current 6 months before and after travel</option>&#13;
			<option label="Yes, but my passport will not be current 6 months before and after traveling" value="yes-but-my-passport-will-not-be-current-6-months-before-and-after-traveling">Yes, but my passport will not be current 6 months before and after traveling</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Is there a special occasion?" name="text-1769440450338" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please let us know any important information you would like us to know about your vacation" name="textarea-1769440494788" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Payment Understanding"/>&#13;
		<field type="checkbox-group" required="true" label="I understand that full payment for my cruise vacation will be due 60-120 days before departure. The final payment date heavily depends on the length of the itinerary and stateroom category. Any trip booked after your desired trips due date will require full payment.&amp;nbsp;" name="checkbox-group-1782270922905">&#13;
			<option label="Yes, I understand" value="yes-i-understand">Yes, I understand</option>&#13;
			<option label="No, I don't understand. Please explain to me" value="no-i-dont-understand-please-explain-to-me">No, I don't understand. Please explain to me</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>