Sara Reese

Peacock Travel Group/Frosch

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		<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" 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="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Address"/>&#13;
		<field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Country" name="address-country" 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="h1" label="ABOUT YOUR TRIP"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates flexible?" 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="What&amp;nbsp; is your departure city/preferred starting airport?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="At what phase of planning are you in?" name="at-what-phase-of-planning-are-you-in">&#13;
			<option label="Just getting started with no details defined" value="just-getting-started-with-no-details-defined">Just getting started with no details defined</option>&#13;
			<option label="We have dates, but we need everything else." value="we-have-dates-but-we-need-everything-else">We have dates, but we need everything else.</option>&#13;
			<option label="Flights are all booked...now help us fill in the blanks." value="flights-are-all-bookednow-help-us-fill-in-the-blanks">Flights are all booked...now help us fill in the blanks.</option>&#13;
			<option label="We have hotels and flights already booked." value="we-have-hotels-and-flights-already-booked">We have hotels and flights already booked.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers? This just gives me a general starting point and can always be changed later." name="what-is-your-budget-for-all-travelers-this-just-gives-me-a-general-starting-point-and-can-always-be-changed-later">&#13;
			<option label="$3,000 - $4,000" value="3000-4000">$3,000 - $4,000</option>&#13;
			<option label="$4,000 - $5,000" value="4000-5000">$4,000 - $5,000</option>&#13;
			<option label="$5,000 - $7,000" value="5000-7000">$5,000 - $7,000</option>&#13;
			<option label="$7,000 - $10,000" value="7000-10000">$7,000 - $10,000</option>&#13;
			<option label="$10,000 +" value="10000-">$10,000 +</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What travel components would you like us to assist you with? Check all that apply." name="what-travel-components-would-you-like-us-to-assist-you-with-check-all-that-apply">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Transportation (car rental, trains, etc.)" value="transportation-car-rental-trains-etc">Transportation (car rental, trains, etc.)</option>&#13;
			<option label="Excursions &amp; tours" value="excursions-tours">Excursions &amp; tours</option>&#13;
			<option label="Insurance" value="insurance">Insurance</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Please list full names (including middle) for ALL travelers, as listed on passport or driver's license.&amp;nbsp; Please list each traveler's birthdate after their name." name="who-all-will-be-traveling-with-you-please-list-all-full-names-including-middle-and-birthdates-as-listed-on-passport" className="form-control"/>&#13;
		<field type="radio-group" label="Is this vacation to celebrate anything special?" name="is-this-vacation-to-celebrate-anything-special">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Graduation" value="graduation">Graduation</option>&#13;
			<option label="Retirement" value="retirement">Retirement</option>&#13;
		</field>&#13;
		<field type="textarea" label="Do you want to stay onsite at a Universal owned resort?&amp;nbsp; Do you know which resort you would like to stay in?" name="do-you-want-to-stay-onsite-at-a-disney-owned-resort-do-you-know-which-resort-you-would-like-to-stay-in" className="form-control"/>&#13;
		<field type="radio-group" label="How many days of Theme Park tickets do you desire?" name="how-many-days-of-theme-park-tickets-do-you-desire">&#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="textarea" label="Text Area" name="textarea-1718564155892" className="form-control"/>&#13;
		<field type="radio-group" label="Do you want the Park to Park add on to your tickets?&amp;nbsp; (This allows you to visit both Universal Studios and Islands of Adventure in the same day.&amp;nbsp; &amp;nbsp;You will need this add on if you wish to ride Hogwart's Express between the Worlds of Harry Potter)" name="do-you-want-park-hopper-tickets-this-allows-you-to-visit-more-than-one-theme-park-per-day">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you like to visit the water park, Volcano Bay?" name="would-you-like-the-memory-maker-photo-package">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you interested in adding travel protection to your vacation package?" name="are-you-interested-in-adding-travel-protection-to-your-vacation-package">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="textarea" label="Please let me know any additional information that may help me to plan your vacation." name="please-let-me-know-any-additional-information-that-may-help-me-to-plan-your-vacation" className="form-control"/>&#13;
		<field type="text" label="How did you hear about us?" name="how-did-you-hear-about-us" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like to be subscribed to our newsletter and travel updates?" name="would-you-like-to-be-subscribed-to-our-newsletter-and-travel-updates" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="By submitting this client inquiry form, you consent to receive travel related content via email from Peacock Travel Group."/>&#13;
	</fields>&#13;
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