Share your information with Leslie Kaczanowski

Leslie Kaczanowski

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  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="All Inclusive Vacation Request"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you so much for choosing me to help book your all inclusive vacation getaway!&amp;nbsp; My average proposal turn around is 72 business hours. Please feel free to email me at any time with any questions! lesliekaczanowski@travelmation.net. I cannot wait to start planning your vacation! *Filling out this form will automatically include you in my monthly newsletter email, if you wish to opt out, please say so in the comments at the bottom. "/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" 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" required="true" label="Do you have accessibility needs?" name="do-you-have-accessibility-needs">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Accessibility Need Information" description="If Yes  please give me a little information to help me best serve you  If no feel free to skip :)" name="accessibility-need-information" className="form-control"/>&#13;
		<field type="text" required="true" label="What is the total number of nights you would like to vacation for? " name="what-is-the-total-number-of-nights-you-would-like-to-vacation-for-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Are you vacationing to celebrate anything? " description="If a birthday/anniversary/honeymoon  what is that date? If not celebrating anything  please put NA" name="are-you-vacationing-to-celebrate-anything-" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When you would like to depart?" description="This can be changed if needed later." name="what-is-your-departure-date" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="what-is-your-return-date" className="form-control"/>&#13;
		<field type="select" required="true" label="Are your dates flexible?" name="are-your-dates-flexible" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, Please tell me what month/time frame you are able to depart and return. " description="I.e. We can travel any 7 nights between Oct 15th and Nov 22nd" name="if-yes-please-tell-me-what-monthtime-frame-you-are-able-to-depart-and-return-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Have you ever been to an All Inclusive? If so, Where?" name="have-you-ever-been-to-an-all-inclusive-if-so-where" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Will you require airfare?" name="will-you-require-airfare" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="We are booking our own airfare" value="we-are-booking-our-own-airfare">We are booking our own airfare</option>&#13;
		</field>&#13;
		<field type="text" label="If yes, What airport are you departing from?" name="if-yes-what-airport-are-you-departing-from" subtype="text" className="form-control"/>&#13;
		<field type="text" label="If yes, do you have a preferred airline?" name="if-yes-do-you-have-a-preferred-airline" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers in your party?" name="how-many-travelers-in-your-party" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First and Last Names AND birth dates for all traveling individuals" description="I will need the spelling and birth date to match EXACTLY what the passport is/will be." name="names-and-birth-dates-of-all-traveling-individuals" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Does EVERYONE in your party have valid U.S. Passports?" description="Valid Passports must NOT expire for 6 months POST return back to the United States.. Please keep in mind that the enhanced licence does NOT allow for flying into Mexico or Canada. You WILL need a passport if you are planning on flying." name="does-everyone-in-your-party-have-valid-us-passports" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="We have already applied" value="we-have-already-applied">We have already applied</option>&#13;
			<option label="We need to apply" value="we-need-to-apply">We need to apply</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything you would like me to know about your passport(s)?" name="is-there-anything-you-would-like-me-to-know-about-your-passports" rows="4" className="form-control"/>&#13;
		<field type="select" required="true" label="Budget total for all individuals" description="The total amount you would like to spend on the trip. This amount would be the total amount for all party members. Please keep in mind  that current airline prices are high  roughly 1200-1500 for 2 people to fly to Cancun  Mexico." placeholder="$6 500-$8 500" name="budget-total-for-all-individuals" className="form-control">&#13;
			<option label="$2,500-$4,500" value="25004500">$2,500-$4,500</option>&#13;
			<option label="$4,500- $6,500" value="45006500">$4,500- $6,500</option>&#13;
			<option label="$6,500-$8,500" value="65008500">$6,500-$8,500</option>&#13;
			<option label="$8,500-$10,000" value="850010000">$8,500-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What best describes your hotel preference?" placeholder="Deluxe - I like ease and convenience and I am willing to pay for it." name="what-best-describes-your-hotel-preference" className="form-control">&#13;
			<option label="Value - I like lower priced rooms and options." value="value-i-like-lower-priced-rooms-and-options">Value - I like lower priced rooms and options.</option>&#13;
			<option label="Moderate - I want the best bang for my buck! " value="moderate-i-want-the-best-bang-for-my-buck-">Moderate - I want the best bang for my buck! </option>&#13;
			<option label="Deluxe - I like ease and convenience and I am willing to pay for it. " value="deluxe-i-like-ease-and-convenience-and-i-am-willing-to-pay-for-it-">Deluxe - I like ease and convenience and I am willing to pay for it. </option>&#13;
			<option label="Luxury - I want the best of the best." value="luxury-i-want-the-best-of-the-best">Luxury - I want the best of the best.</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="What type of all inclusive are you seeking?" description="Adults Only - 18 and up | Family Friendly - Children will be present" name="what-type-of-all-inclusive-are-you-seeking" className="form-control">&#13;
			<option label="Adults Only" value="adults-only">Adults Only</option>&#13;
			<option label="Family Friendly" value="family-friendly">Family Friendly</option>&#13;
			<option label="Option 3" value="option-3">Option 3</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="What activities are you interested in? Select all that apply" name="what-activities-are-you-interested-in-select-all-that-apply">&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Water Sports" value="water-sports">Water Sports</option>&#13;
			<option label="Family Fun Activities" value="family-fun-activities">Family Fun Activities</option>&#13;
			<option label="Adventure  Activites" value="adventure-activites">Adventure  Activites</option>&#13;
			<option label="Architecture Experiences" value="architecture-experiences">Architecture Experiences</option>&#13;
			<option label="Reading By A Quiet Pool" value="reading-by-a-quiet-pool">Reading By A Quiet Pool</option>&#13;
			<option label="Music and High Energy Areas" value="music-and-high-energy-areas">Music and High Energy Areas</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Night Life" value="night-life">Night Life</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Arts and Theatre" value="arts-and-theatre">Arts and Theatre</option>&#13;
			<option label="I'm a Foodie" value="im-a-foodie">I'm a Foodie</option>&#13;
			<option label="I prefer the beach" value="i-prefer-the-beach">I prefer the beach</option>&#13;
			<option label="I prefer the pool" value="i-prefer-the-pool">I prefer the pool</option>&#13;
			<option label="I love both the beach and the pool" value="i-love-both-the-beach-and-the-pool">I love both the beach and the pool</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Anything you absolutely must see or do?" description="If you are unsure or don&#39;t have a preference please put NA" name="anything-you-absolutely-must-see-or-do" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What else would you like me to know?" name="what-else-would-you-like-me-to-know" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Who can I thank for referring you?" name="who-can-i-thank-for-referring-you" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
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