Share your information with Jaimie Harvey

Jaimie Harvey

Free to Dream Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Contact Information"/>&#13;
		<field type="text" required="true" label="First name" name="first-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="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="text" required="true" label="What destination would you like to visit?" description="If you&#39;re not sure  just give me a few destinations you&#39;re considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control"/>&#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="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults/children are in your travel party? Please list children&#39;s ages at the time of travel." name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="When is the last time you visited this destination?" name="when-is-the-last-time-you-visited-this-destination">&#13;
			<option label="Never" value="never">Never</option>&#13;
			<option label="Within the last 2 years" value="within-the-last-2-years">Within the last 2 years</option>&#13;
			<option label="2-5 years ago" value="25-years-ago">2-5 years ago</option>&#13;
			<option label="5-10 years ago" value="510-years-ago">5-10 years ago</option>&#13;
			<option label="Over 10 years ago" value="over-10-years-ago">Over 10 years ago</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="What are you comfortable spending for this vacation?" name="do-you-have-a-resort-preference" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are you most excited about for your vacation?" name="what-are-you-most-excited-about-for-your-vacation" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What are you most nervous about for your vacation?" name="what-are-you-most-nervous-about-for-your-vacation" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Please include any additional information that will help me customize your vacation package." description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Walt Disney World only (please inquire about Disneyland or Aulani)"/>&#13;
		<field type="radio-group" label="Disney requires a $200 deposit. The balance of your trip is due in full 30 days before you travel. Are you able to make the $200 deposit at the time of your booking?" name="disney-requires-a-200-deposit-the-balance-of-your-trip-is-due-in-full-30-days-before-you-travel-are-you-able-to-make-the-200-deposit-at-the-time-of-your-booking">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Cruises Only"/>&#13;
		<field type="paragraph" subtype="p" label="Is there a specific cruise line you prefer sailing with?"/>&#13;
		<field type="radio-group" label="Do all guests in your party have a valid US Passport?" name="do-all-guests-in-your-party-have-a-valid-us-passport">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a specific itinerary or ports you are interested in?" name="do-you-have-a-specific-itinerary-you-are-interested-in" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Universal Destinations"/>&#13;
		<field type="paragraph" subtype="p" label="Please only fill out the questions in this area if you are wanting a Universal Orlando Resort (Florida) or a Universal Studios Hollywood (California) vacation."/>&#13;
		<field type="checkbox-group" label="Are you interested in Universal Orlando or Universal Studios Hollywood?" name="are-you-interested-in-universal-orlando-or-universal-studios-hollywood">&#13;
			<option label="Universal Orlando (Florida)" value="">Universal Orlando (Florida)</option>&#13;
			<option label="Universal Studios Hollywood (California)" value="universal-studios-hollywood-california">Universal Studios Hollywood (California)</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>