Share your information with Jenna Brown

Jenna Brown

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		<field type="header" subtype="h2" label="Full name"/>&#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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Trip Questions"/>&#13;
		<field type="date" required="true" label="Check-in date" name="checkin-date" className="form-control"/>&#13;
		<field type="date" required="true" label="Check-out date" name="checkout-date" className="form-control"/>&#13;
		<field type="text" required="true" label="Are your dates flexible? If yes, what month or time of year are you looking to travel?&amp;nbsp;" name="are-your-dates-flexible-if-yes-what-month-or-time-of-year-are-you-looking-to-travel-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="How many people are in your travel party?&amp;nbsp;" placeholder="Please include the birthdates for anyone under the age of 18" name="how-many-people-are-in-your-travel-party-" value="Please include the birthdates for anyone under the age of 18" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What is your preferred room type? If you would like more than one room, how would you like them divided?" placeholder="ex: Room 1: 2 Adults  2 kids (3&amp;amp;6)- 2 queen/double beds  Room 2: 2 adults - 1 king bed)" name="what-is-your-preferred-room-type-if-you-would-like-more-than-one-room-how-would-you-like-them-divided" value="ex: Room 1: 2 Adults  2 kids (3&amp;amp;6)- 2 queen/double beds   Room 2: 2 adults - 1 king bed" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your estimated price point?&amp;nbsp;" description="This just gives me a general starting point and can always be changed later!" name="what-is-your-estimated-price-point-">&#13;
			<option label="$1,500-$2,500" value="15002500">$1,500-$2,500</option>&#13;
			<option label="$2,500-$4,500" value="25004500">$2,500-$4,500</option>&#13;
			<option label="$4,500-$6,500" value="45006500">$4,500-$6,500</option>&#13;
			<option label="$6,500-$8,500" value="65008500">$6,500-$8,500</option>&#13;
			<option label="$8,500-$10,000" value="850010000">$8,500-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Do you know how many park days you would like? If yes, how many?" name="how-many-park-days-are-you-wanting" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What type of park ticket would you like?&amp;nbsp;" name="what-type-of-park-ticket-would-you-like-">&#13;
			<option label="Base Ticket: Admission to 1 park per day" value="base-ticket-admission-to-1-park-per-day">Base Ticket: Admission to 1 park per day</option>&#13;
			<option label="Park Hopper Ticket: Admission to both parks per day" value="park-hopper-ticket-admission-to-both-parks-per-day">Park Hopper Ticket: Admission to both parks per day</option>&#13;
			<option label="Not sure yet!" value="not-sure-yet">Not sure yet!</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you have a hotel preference?&amp;nbsp;" name="do-you-have-a-hotel-preference-">&#13;
			<option label="Disney-Owned Hotel" value="disneyowned-hotel">Disney-Owned Hotel</option>&#13;
			<option label="Good-Neighbor Hotel" value="goodneighbor-hotel">Good-Neighbor Hotel</option>&#13;
			<option label="No preference! " value="no-preference-">No preference! </option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="Can you apply any of these discounts?" name="can-you-apply-any-of-these-discounts">&#13;
			<option label="California Resident" value="california-resident">California Resident</option>&#13;
			<option label="Military" value="military">Military</option>&#13;
			<option label="Disney + Subscriber" value="disney-subscriber">Disney + Subscriber</option>&#13;
			<option label="Magic Key Holder" value="magic-key-holder">Magic Key Holder</option>&#13;
			<option label="Disney Chase Visa Cardholder" value="disney-chase-visa-cardholder">Disney Chase Visa Cardholder</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Is there any other information that I should know?" description="You may want to include any celebrations (birthdays  anniversary  graduations  etc)  disabilities I should be aware of when booking your vacation or if anyone in your family has a particular Disney interest!" name="is-there-any-other-information-that-i-should-know" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="Thank you so much for taking the time to fill out this inquiry. Please allow for 48 hours for a response, every vacation quote is custom tailored by me to fit your family&#39;s wants and needs! Don&#39;t forget to check your spam folder!&amp;nbsp;"/>&#13;
	</fields>&#13;
</form-template>
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