Cheri Panzloff

Travel Mon Cheri LLC

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	<fields>&#13;
		<field type="header" subtype="h2" label="&amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp; &amp;nbsp;QUOTE REQUEST"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" 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" 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="text" required="true" label="What City Are You Located In &amp;nbsp;/Airport Flying From?" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What Kind Of Vacation Are You Looking For? &amp;nbsp; &amp;nbsp; &amp;nbsp; ie: Group of Friends/Family, All Inclusive, Europe, Ocean Cruise, Expedition Cruise, etc." name="what-kind-of-vacation-are-you-looking-for-ie-group-of-friendsfamily-all-inclusive-europe-ocean-cruise-expedition-cruise-etc" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are you ready to book?" name="are-you-ready-to-book">&#13;
			<option label="Deposit Ready for the Best Price/Early Booking!" value="deposit-ready-for-the-best-priceearly-booking">Deposit Ready for the Best Price/Early Booking!</option>&#13;
			<option label="Ready in a week-  " value="ready-in-a-week-">Ready in a week-  </option>&#13;
			<option label="I will be ready in 2 weeks or more- (will risk availabiiity and price changes)" value="i-will-be-ready-in-2-weeks-or-more-will-risk-availabiiity-and-price-changes">I will be ready in 2 weeks or more- (will risk availabiiity and price changes)</option>&#13;
			<option label="I saw one of your deals and I need to book before it expires" value="i-saw-one-of-your-deals-and-i-need-to-book-before-it-expires">I saw one of your deals and I need to book before it expires</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Insurance (cost will be added to the deposit)" inline="true" name="insurance-cost-will-be-added-to-the-deposit" other="true">&#13;
			<option label="Travel Credit Option" value="travel-credit-option">Travel Credit Option</option>&#13;
			<option label="Cash Refund Option" value="cash-refund-option">Cash Refund Option</option>&#13;
			<option label="I Will Add It Later I Want To Secure My Room For Now" value="i-will-add-it-later-i-want-to-secure-my-room-for-now">I Will Add It Later I Want To Secure My Room For Now</option>&#13;
			<option label="I Am Not Sure Of The Options But Want Information" value="i-am-not-sure-of-the-options-but-want-information">I Am Not Sure Of The Options But Want Information</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Bed Request (Based on availability at the time of check in)" name="bed-request-based-on-availability-at-the-time-of-check-in">&#13;
			<option label="1 King" value="1-king">1 King</option>&#13;
			<option label="2 Doubles" value="2-doubles">2 Doubles</option>&#13;
			<option label="need crib/cot" value="need-cribcot">need crib/cot</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="How Many people? (Occupancy)" toggle="true" inline="true" name="how-many-people-occupancy" other="true">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
			<option label="4" value="4">4</option>&#13;
			<option label="5+" value="5">5+</option>&#13;
		</field>&#13;
		<field type="text" label="Text Field" name="text-1734250105164" value="Thank you for your request, we look forward to connecting with you soon.  - Cheri" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
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