Share your information with Jennifer Smith

Jennifer Smith

The Hello Agency

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="INQUIRY - CENTRAL AMERICA"/>&#13;
		<field type="header" subtype="h1" label="Client Information"/>&#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="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="date" label="Birthday" name="birthday" 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="textarea" label="Would you like to add anyone to our communications? Please list their name(s) and email(s) below.&amp;nbsp;" name="would-you-like-to-add-anyone-to-our-communications-please-list-their-names-and-emails-below-" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="About Your Trip"/>&#13;
		<field type="textarea" required="true" label="What is the purpose for this vacation? Can you explain a little bit about what you&#39;re looking for?&amp;nbsp;" name="what-is-the-purpose-for-this-vacation-can-you-explain-a-little-bit-about-what-youre-look-for-" className="form-control"/>&#13;
		<field type="textarea" label="Please list the full names of travelers AND their birthdays. If there will be multiple rooms, please provide a breakdown of who goes in each room:&amp;nbsp;" name="please-list-the-full-names-of-travelers-and-their-birthdays-if-there-will-be-multiple-rooms-please-provide-a-breakdown-of-who-goes-in-each-room-" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Destination(s) to visit on this trip:&amp;nbsp;" name="preferred-destinations-to-visit-on-this-trip-" other="true">&#13;
			<option label="Costa Rica" value="costa-rica">Costa Rica</option>&#13;
			<option label="Belize" value="belize">Belize</option>&#13;
			<option label="Nicaragua" value="nicaragua">Nicaragua</option>&#13;
			<option label="Panama" value="panama">Panama</option>&#13;
			<option label="Guatemala" value="guatemala">Guatemala</option>&#13;
		</field>&#13;
		<field type="text" label="Are there any destinations that you want to avoid:&amp;nbsp;" name="are-there-any-destinations-that-you-want-to-avoid-" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to depart?&amp;nbsp;" name="when-would-you-like-to-depart-" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?&amp;nbsp;" name="when-would-you-like-to-return-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Are your dates flexible?&amp;nbsp;" name="are-your-dates-flexible-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="If flexible, please share a date range. *If sharing a range of dates, please list exact date ranges vs. general availability.&amp;nbsp;" name="if-flexible-please-share-a-date-range-if-sharing-a-range-of-dates-please-list-exact-date-ranges-vs-general-availability-" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="What is your estimated investment for all travelers (excluding flights, excursions, and optional travel insurance)?&amp;nbsp;" name="what-is-your-estimated-investment-for-all-travelers-excluding-flights-excursions-and-optional-travel-insurance-">&#13;
			<option label="$5,000-$8,000" value="50008000">$5,000-$8,000</option>&#13;
			<option label="$8,000-$12,000" value="800012000">$8,000-$12,000</option>&#13;
			<option label="$12,000+" value="12000">$12,000+</option>&#13;
			<option label="Not Listed Above" value="not-listed-above">Not Listed Above</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Which of the following is important to you (check all that apply)?" name="which-of-the-following-is-important-to-you-check-all-that-apply" other="true">&#13;
			<option label="Authentic/Local Accommodations (3-4 Star)" value="authenticlocal-accommodations-34-star">Authentic/Local Accommodations (3-4 Star)</option>&#13;
			<option label="Boutique Hotel " value="boutique-hotel-">Boutique Hotel </option>&#13;
			<option label="Villa/Condo Resort" value="villacondo-resort">Villa/Condo Resort</option>&#13;
			<option label="Luxury Resort (5 Star)" value="luxury-resort-5-star">Luxury Resort (5 Star)</option>&#13;
			<option label="Adult-Only Hotel " value="adultonly-hotel-">Adult-Only Hotel </option>&#13;
			<option label="Beach On-Site " value="beach-onsite-">Beach On-Site </option>&#13;
			<option label="Multiple Restaurants On-Site " value="multiple-restaurants-onsite-">Multiple Restaurants On-Site </option>&#13;
			<option label="Spa On-Site" value="spa-onsite">Spa On-Site</option>&#13;
			<option label="Gym On-Site " value="gym-onsite-">Gym On-Site </option>&#13;
			<option label="AC Required" value="ac-required">AC Required</option>&#13;
			<option label="Handicap Accessible " value="handicap-accessible-">Handicap Accessible </option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Room Preference:&amp;nbsp;" name="room-preference-" other="true">&#13;
			<option label="King Preferred (with Sleeper Sofa, if applicable) " value="king-preferred-with-sleeper-sofa-if-applicable-">King Preferred (with Sleeper Sofa, if applicable) </option>&#13;
			<option label="2 Queens (or 2 beds)" value="2-queens-or-2-beds">2 Queens (or 2 beds)</option>&#13;
			<option label="Connecting Rooms" value="connecting-rooms">Connecting Rooms</option>&#13;
			<option label="Suite (Bedroom and Den Space separated by a door)" value="suite-bedroom-and-den-space-separated-by-a-door">Suite (Bedroom and Den Space separated by a door)</option>&#13;
			<option label="Villa/Condo/House (Multiple Bedrooms and Living Space)" value="villacondohouse-multiple-bedrooms-and-living-space">Villa/Condo/House (Multiple Bedrooms and Living Space)</option>&#13;
		</field>&#13;
		<field type="radio-group" label="If applicable, is it a deal breaker if rooms do not connect?&amp;nbsp;" name="if-applicable-is-it-a-deal-breaker-if-rooms-do-not-connect-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Activities of Interest: (this helps us place you in the correct locations)&amp;nbsp;" name="activities-of-interest-this-helps-us-place-you-in-the-correct-locations-" other="true">&#13;
			<option label="Snorkeling" value="snorkeling">Snorkeling</option>&#13;
			<option label="Diving" value="diving">Diving</option>&#13;
			<option label="Zipline" value="zipline">Zipline</option>&#13;
			<option label="Hiking" value="hiking">Hiking</option>&#13;
			<option label="Biking" value="biking">Biking</option>&#13;
			<option label="Whitewater Rafting" value="whitewater-rafting">Whitewater Rafting</option>&#13;
			<option label="Kayaking" value="kayaking">Kayaking</option>&#13;
			<option label="Whale Watching" value="whale-watching">Whale Watching</option>&#13;
			<option label="Horseback Riding" value="horseback-riding">Horseback Riding</option>&#13;
			<option label="Deep Sea Fishing" value="deep-sea-fishing">Deep Sea Fishing</option>&#13;
			<option label="Cultural Visits" value="cultural-visits">Cultural Visits</option>&#13;
			<option label="Interaction With Wildlife " value="interaction-with-wildlife-">Interaction With Wildlife </option>&#13;
			<option label="History" value="history">History</option>&#13;
			<option label="Surfing" value="surfing">Surfing</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="These locations require longer travel times and transfers. Does anyone in your party get car sick?&amp;nbsp;" name="these-locations-require-longer-travel-times-and-transfers-does-anyone-in-your-party-get-car-sick-" other="true">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Is everyone a US citizen, with a passport valid for at least 6 months after your return?&amp;nbsp;" name="is-everyone-a-us-citizen-with-a-passport-valid-for-at-least-6-months-after-your-return-" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Final Notes To Further Customize Your Travel"/>&#13;
		<field type="textarea" label="Any other notes on your preferences or dreams for this trip to help me tailor it for you?" name="any-other-notes-on-your-preferences-or-dreams-for-this-trip-to-help-me-tailor-it-for-you" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="By submitting this client inquiry form, you consent to have reviewed the Terms &amp;amp; Conditions of working with The Hello Agency. Please visit https://thehelloagency.com/terms-of-service to review. I also understand that I am required to pay a non-refundable Professional Planning fee. This will be paid directly to The Hello Agency and will be discussed prior to you scheduling a planning call. Initial Planning Calls are Complimentary."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>