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Candice Ortiz
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<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Let's plan that theme park trip!!"/> <field type="paragraph" subtype="p" label="Please complete this form so that I can get started on planning the perfect vacation for you! The quote is always free to you. Please allow 2-3 business days for a response once the form has been submitted."/> <field type="header" subtype="h2" label="Contact Info"/> <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="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <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="header" subtype="h2" label="Questions for your trip"/> <field type="text" label="Where would you like to go?" placeholder="ex: Disney World DisneyLand, Universal Orlando, Universal Hollywood etc." name="destination" subtype="text" className="form-control"/> <field type="text" label="When would you like to travel?" description="share specific dates or a desired time frame that you would like to travel in." placeholder="specific dates season or approximate travel dates." name="text-1734384417518" subtype="text" className="form-control"/> <field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" label="How soon are you looking to book?" name="how-soon-are-you-looking-to-book"> <option label="Today" value="today">Today</option> <option label="Within the next 7-10 days" value="within-the-next-710-days">Within the next 7-10 days</option> <option label="In a few months" value="in-a-few-months">In a few months</option> <option label="Just considering options" value="just-considering-options">Just considering options</option> </field> <field type="text" label="What is your departure city/airport?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="text" required="true" label="How many travelers?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="text" required="true" label="Full name, birthdate, and gender of each traveler in the party" description="please write the name as it appears on their birth certificate passport or driver's license" placeholder="Ex: Candice Ortiz - 04/09/1986 - Female" name="full-names-of-each-traveler" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What is your budget for all travelers (without airfare)?" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$1,500 to $3,500" value="1500-to-3500">$1,500 to $3,500</option> <option label="$3,500 - $6,000" value="3500-6000">$3,500 - $6,000</option> <option label="$6,000 - $9,000" value="6000-9000">$6,000 - $9,000</option> <option label="$9,000 - $15,000" value="9000-15000">$9,000 - $15,000</option> <option label="$15,000 - $25,000" value="15000-25000">$15,000 - $25,000</option> <option label="$25,000+" value="25000">$25,000+</option> </field> <field type="checkbox-group" label="Are you celebrating anything?" name="are-you-celebrating-anything"> <option label="Honeymoon" value="honeymoon">Honeymoon</option> <option label="Birthday" value="birthday">Birthday</option> <option label="Anniversary" value="anniversary">Anniversary</option> <option label="Graduation" value="graduation">Graduation</option> <option label="Retirement" value="retirement">Retirement</option> <option label="First Visit" value="first-visit">First Visit</option> <option label="Other" value="other">Other</option> <option label="None" value="none">None</option> </field> <field type="checkbox-group" required="true" label="There are special discounts for certain groups. Do you fall into any of these categories?" description="select all that apply" name="checkbox-group-1734393456338"> <option label="Active, retired, or 100% disabled military (military ID required)" value="active-retired-or-100-disabled-military-military-id-required">Active, retired, or 100% disabled military (military ID required)</option> <option label="Disney Visa Cardholder" value="disney-visa-cardholder">Disney Visa Cardholder</option> <option label="Annual Passholder" value="annual-passholder">Annual Passholder</option> <option label="Disney Plus Subscriber" value="disney-plus-subscriber">Disney Plus Subscriber</option> <option label="Florida Resident" value="florida-resident">Florida Resident</option> <option label="Southern California Resident (zip code 9000-96199)" value="southern-california-resident-zip-code-900096199">Southern California Resident (zip code 9000-96199)</option> <option label="None" value="none">None</option> </field> <field type="radio-group" label="Tell me about your previous Disney experience" name="are-you-interested-in-travel-insurance"> <option label="This is my first time staying at a Disney Resort" value="this-is-my-first-time-staying-at-a-disney-resort">This is my first time staying at a Disney Resort</option> <option label="I've stayed at Disney 1-3 times" value="ive-stayed-at-disney-13-times">I've stayed at Disney 1-3 times</option> <option label="I've stayed at Disney 4+ times" value="ive-stayed-at-disney-4-times">I've stayed at Disney 4+ times</option> </field> <field type="checkbox-group" required="true" label="What best describes your hotel preference?" description="You may select more than one option" name="checkbox-group-1734393699849"> <option label="Value - $ (from $150+ per night) - Motel style exterior entrances, themed pools, food court and poolside bar. Most hotels sleep up to 4 guests plus a baby in a crib." value="value-from-150-per-night-motel-style-exterior-entrances-themed-pools-food-court-and-poolside-bar-most-hotels-sleep-up-to-4-guests-plus-a-baby-in-a-crib">Value - $ (from $150+ per night) - Motel style exterior entrances, themed pools, food court and poolside bar. Most hotels sleep up to 4 guests plus a baby in a crib.</option> <option label="Moderate - $$ (from $250+ per night) - Motel style exterior entrances, bigger rooms than value resorts, themed pools with waterslides, food court and poolside bar, plus sit-down restaurants on site. Some rooms in this category sleep up to 5 guests plus a baby in a crib." value="moderate-from-250-per-night-motel-style-exterior-entrances-bigger-rooms-than-value-resorts-themed-pools-with-waterslides-food-court-and-poolside-bar-plus-sitdown-restaurants-on-site-some-rooms-in-this-category-sleep-up-to-5-guests-plus-a-baby-in-a-crib">Moderate - $$ (from $250+ per night) - Motel style exterior entrances, bigger rooms than value resorts, themed pools with waterslides, food court and poolside bar, plus sit-down restaurants on site. Some rooms in this category sleep up to 5 guests plus a baby in a crib.</option> <option label="Deluxe - $$$ (from $350+ per night) - Hotel style, biggest rooms, themed pools with waterslides, multiple dining options on-site (food court, poolside bar, multiple sit-down restaurants on-site). Multiple sleeping arrangements from 4-6+ people." value="deluxe-from-350-per-night-hotel-style-biggest-rooms-themed-pools-with-waterslides-multiple-dining-options-onsite-food-court-poolside-bar-multiple-sitdown-restaurants-onsite-multiple-sleeping-arrangements-from-46-people">Deluxe - $$$ (from $350+ per night) - Hotel style, biggest rooms, themed pools with waterslides, multiple dining options on-site (food court, poolside bar, multiple sit-down restaurants on-site). Multiple sleeping arrangements from 4-6+ people.</option> <option label="Fort Wilderness Campground - Walt Disney World only" value="fort-wilderness-campground-walt-disney-world-only">Fort Wilderness Campground - Walt Disney World only</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="If you have a specific hotel in mind, please list it below." name="if-you-have-a-specific-hotel-in-mind-please-list-it-below" subtype="text" className="form-control"/> <field type="text" required="true" label="How many days would you like to visit the parks?" name="how-many-days-would-you-like-to-visit-the-parks" subtype="text" className="form-control"/> <field type="radio-group" required="true" label="What kind of ticket would you like?" name="radio-group-1734393636960"> <option label="Base ticket - one park per day" value="base-ticket-one-park-per-day">Base ticket - one park per day</option> <option label="Park Hopper ticket - visiting more than one park per day" value="park-hopper-ticket-visiting-more-than-one-park-per-day">Park Hopper ticket - visiting more than one park per day</option> <option label="N/A (hotel only)" value="na-hotel-only">N/A (hotel only)</option> </field> <field type="checkbox-group" required="true" label="Are you interested in adding Special Event Tickets or VIP tours?&nbsp;" description="such as Mickey's Not So Scary Halloween Jollywood Nights, Mickey's Very Merry Christmas Party, etc." name="are-you-interested-in-adding-special-event-tickets-or-vip-tours-"> <option label="Mickey's Not So Scary Halloween Party" value="mickeys-not-so-scary-halloween-party">Mickey's Not So Scary Halloween Party</option> <option label="Mickey's Very Merry Christmas Party" value="mickeys-very-merry-christmas-party">Mickey's Very Merry Christmas Party</option> <option label="Disney's Jollywood Nights" value="disneys-jollywood-nights">Disney's Jollywood Nights</option> <option label="Universal Studio's Halloween Horror Nights" value="universal-studios-halloween-horror-nights">Universal Studio's Halloween Horror Nights</option> <option label="Universal VIP Experience" value="universal-vip-experience">Universal VIP Experience</option> <option label="Disney Private VIP Tour" value="disney-private-vip-tour">Disney Private VIP Tour</option> <option label="Other" value="other">Other</option> <option label="No thank you!" value="no-thank-you">No thank you!</option> </field> <field type="radio-group" required="true" label="Do you want to include travel protection?" name="radio-group-1734393897851"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Maybe" value="maybe">Maybe</option> </field> <field type="radio-group" required="true" label="Do you want to include Memory Maker?" description="For $189 total Memory Maker Includes: • Magic Shots – featuring Disney characters and more, added to your photos • Iconic, professional photos taken by Disney PhotoPass photographers • Select attraction photos and videos • Digital Downloads of your Disney PhotoPass photos and videos" name="radio-group-1734394307291"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Maybe" value="maybe">Maybe</option> </field> <field type="select" label="How will you get to your destination?&nbsp;" description="what is your planned method of transportation?" name="how-will-you-get-to-your-destination-" className="form-control"> <option label="I will be flying to my destination" value="i-will-be-flying-to-my-destination">I will be flying to my destination</option> <option label="I will be driving to my destination" value="i-will-be-driving-to-my-destination">I will be driving to my destination</option> <option label="I will be taking the train to my destination" value="i-will-be-taking-the-train-to-my-destination">I will be taking the train to my destination</option> </field> <field type="text" label="Who can I thank for referring you to me?" name="who-can-i-thank-for-referring-you-to-me" subtype="text" className="form-control"/> <field type="text" label="Any food allergies / medical conditions / special needs to be made aware of?&nbsp;" description="Diabetic autism spectrum wheel chair gluten-free etc." name="are-there-any-handicaps-or-special-needs-that-we-should-make-accommodations-for" subtype="text" className="form-control"/> <field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers budget and/or travel preferences?" name="notes" className="form-control"/> <field type="checkbox-group" required="true" label="By submitting this request, you are giving me permission to text the phone number above with relevant information concerning your request, and to add your email to my email list" name="by-submitting-this-request-you-are-giving-me-permission-to-text-the-phone-number-above-with-relevant-information-concerning-your-request-and-to-add-your-email-to-my-email-list"> <option label="Yes, I understand! Please text!" value="yes-i-understand-please-text">Yes, I understand! Please text!</option> <option label="I understand, but please don't text me. " value="i-understand-but-please-dont-text-me-">I understand, but please don't text me. </option> </field> </fields> </form-template> </body> </html>
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