<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Contact Information"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="date" required="true" label="Date of Birth (As it is on the birth certificate, will be verified by birth certificate at the port)" name="date-of-birth-as-it-is-on-the-birth-certificate-will-be-verified-by-birth-certificate-at-the-port" className="form-control"/> <field type="textarea" label="Please list any additional travelers in this cabin below.&nbsp; Include Name, Date of Birth and Email Address" name="please-list-any-additional-travelers-in-this-cabin-below-include-name-date-of-birth-and-email-address" className="form-control"/> <field type="text" required="true" label="Primary email address" name="email" subtype="text" className="form-control"/> <field type="text" label="Primary phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" label="Best time to contact you?" name="best-time-to-contact-you" subtype="text" className="form-control"/> <field type="checkbox-group" label="What's your preferred method of contact?&nbsp;" name="whats-your-preferred-method-of-contact-"> <option label="Email" value="email">Email</option> <option label="Phone" value="phone">Phone</option> <option label="Text" value="text">Text</option> </field> <field type="header" subtype="h2" label="Address"/> <field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="text" required="true" label="How many travelers?&nbsp;" name="how-many-travelers-" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Vacation Information"/> <field type="radio-group" label="Cabin Preference" name="seat-preference"> <option label="Interior" value="interior">Interior</option> <option label="Oceanview" value="oceanview">Oceanview</option> <option label="Balcony" value="balcony">Balcony</option> </field> <field type="radio-group" label="Would you like to include gratuities now or after you board the ship? (Tips for cruise staff, must be paid at some time)" name="would-you-like-to-include-gratuities-now-or-after-you-board-the-ship"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" label="Will you need transportation to depart port?" name="radio-group-1655820117419"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" label="Have you ever been on a cruise?" name="have-you-ever-been-on-a-cruise"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="If Yes, Please Include Your Rewards Number" name="if-yes-please-include-your-rewards-number" subtype="text" className="form-control"/> <field type="textarea" label="Will anyone in your group be celebrating any occasions or events?" name="will-anyone-in-your-group-be-celebrating-any-occasions-or-events" className="form-control"/> <field type="checkbox-group" label="Are you interested in any Desired Excursions/Tours/Interest?&nbsp; If so please select activity preferences" name="activity-preferences"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theatre" value="art-theatre">Arts and theatre</option> <option label="Culture" value="culture">Culture</option> </field> <field type="textarea" label="What else would you like me to know?" name="what-else-would-you-like-me-to-know" className="form-control"/> <field type="radio-group" label="What best describes your hotel preference?" name="hotel-preference"> <option label="Economy" value="value">Economy</option> <option label="Moderate" value="moderate">Moderate</option> <option label="Luxury" value="luxury">Luxury</option> <option label="Boutique" value="boutique">Boutique</option> </field> <field type="clientLoyaltyPrograms" label="Loyalty Programs" name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="checkbox-group" label="Promotional Qualifiers" name="promotional-qualifiers"> <option label=" Age 55+" value=" Age 55+"> Age 55+</option> <option label="Law Enforcement" value="law-enforcement">Law Enforcement</option> <option label="Fire Department or EMT" value="fire-department-or-emt">Fire Department or EMT</option> <option label="US Military" value="us-military">US Military</option> </field> <field type="textarea" label="Please include any medical conditions, equipment or allergies (ie. Sleeping Machines, walkers, wheelchairs, scooters etc.)&nbsp;" name="please-include-any-medical-conditions-equipment-or-allergies-ie-sleeping-machines-walkers-wheelchairs-scooters-etc-" className="form-control"/> <field type="radio-group" label="How would you like to make future payments?" name="how-would-you-like-to-make-future-payments" other="true"> <option label="Have Payments Automatically Drafted on the 15th of each month? (Amount will be provided shortly)" value="have-payments-automatically-drafted-on-the-15th-of-each-month-amount-will-be-provided-shortly">Have Payments Automatically Drafted on the 15th of each month? (Amount will be provided shortly)</option> <option label="Maintain Card on file (Call/Email Agent to make payment upon request)" value="maintain-card-on-file-callemail-agent-to-make-payment-upon-request">Maintain Card on file (Call/Email Agent to make payment upon request)</option> <option label="Call Travel Agent to make each payment" value="call-travel-agent-to-make-each-payment">Call Travel Agent to make each payment</option> </field> <field type="text" required="true" label="How did you hear about us?" name="referral" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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