Brooke Blackburn

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Simply Magical Travels Quote Request"/>&#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="select" required="true" label="What destination are you interested in?&amp;nbsp;" name="what-destination-are-you-interested-in-" multiple="multiple" className="form-control">&#13;
			<option label="Walt Disney World in Florida" value="walt-disney-world-in-florida" selected="selected">Walt Disney World in Florida</option>&#13;
			<option label="Disneyland in California" value="disneyland-in-california">Disneyland in California</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Royal Caribbean Cruise Line" value="royal-caribbean-cruise-line">Royal Caribbean Cruise Line</option>&#13;
			<option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Virgin Voyages" value="virgin-voyages">Virgin Voyages</option>&#13;
			<option label="Universal Studios Orlando" value="universal-studios-orlando">Universal Studios Orlando</option>&#13;
			<option label="Universal Studios Hollywood" value="universal-studios-hollywood">Universal Studios Hollywood</option>&#13;
			<option label="Sandals All-Inclusive" value="sandals-allinclusive">Sandals All-Inclusive</option>&#13;
			<option label="Beaches All-Inclusive" value="beaches-allinclusive">Beaches All-Inclusive</option>&#13;
			<option label="Disney's Aulani in Hawaii" value="disneys-aulani-in-hawaii">Disney's Aulani in Hawaii</option>&#13;
			<option label="Somewhere else " value="somewhere-else-">Somewhere else </option>&#13;
		</field>&#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="radio-group" required="true" 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" required="true" label="Total Number of Adults Traveling" name="total-number-of-adults-traveling" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Legal First and Last Name of each Adult in Travel Party" name="legal-first-and-last-name-of-each-adult-in-travel-party" className="form-control"/>&#13;
		<field type="text" required="true" label="Total Number of Children Traveling&amp;nbsp;" name="total-number-of-children-traveling-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Legal First and Last Name &amp;amp; Age (list age at time of travel)" name="legal-first-and-last-name-age-list-age-at-time-of-travel" className="form-control"/>&#13;
		<field type="textarea" required="true" label="If you need more than one room, list how rooms will be split&amp;nbsp;" name="if-you-need-more-than-one-room-list-how-rooms-will-be-split-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Budget Range" inline="true" name="budget-range">&#13;
			<option label="$2000-$3000" value="20003000">$2000-$3000</option>&#13;
			<option label="$3000-$5000" value="30005000">$3000-$5000</option>&#13;
			<option label="$5000-$7000" value="50007000">$5000-$7000</option>&#13;
			<option label="$7000-$10,000" value="700010000">$7000-$10,000</option>&#13;
			<option label="$10,000+" value="10000">$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What type of package?" inline="true" name="what-type-of-package">&#13;
			<option label="Room + Tickets" value="room-tickets">Room + Tickets</option>&#13;
			<option label="Room Only" value="room-only">Room Only</option>&#13;
			<option label="Tickets Only" value="tickets-only">Tickets Only</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="If visiting a theme park, how many days in the parks would you like?&amp;nbsp;" inline="true" name="if-visiting-a-theme-park-how-many-days-in-the-parks-would-you-like-">&#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;
			<option label="6" value="6">6</option>&#13;
			<option label="More than 6" value="more-than-6">More than 6</option>&#13;
			<option label="N/A" value="na">N/A</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="If visiting theme parks, what type of ticket are you thinking?" name="if-visiting-theme-parks-what-type-of-ticket-are-you-thinking" className="form-control">&#13;
			<option label="Base ticket (visit one park per day)" value="base-ticket-visit-one-park-per-day" selected="selected">Base ticket (visit one park per day)</option>&#13;
			<option label="Park Hopper (visit multiple parks in one day)" value="park-hopper-visit-multiple-parks-in-one-day">Park Hopper (visit multiple parks in one day)</option>&#13;
			<option label="Water Park + Sports (visit one park per day + water park)" value="water-park-sports-visit-one-park-per-day-water-park">Water Park + Sports (visit one park per day + water park)</option>&#13;
			<option label="Park Hopper Plus (visit multiple parks + water park)" value="park-hopper-plus-visit-multiple-parks-water-park">Park Hopper Plus (visit multiple parks + water park)</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Interested in the Dining Plan if visiting Walt Disney World?" name="interested-in-the-dining-plan-if-visiting-walt-disney-world" className="form-control">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Possibly- talk me through this" value="possibly-talk-me-through-this">Possibly- talk me through this</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Do you qualify for any discounts?" name="do-you-qualify-for-any-discounts" className="form-control">&#13;
			<option label="Disney Annual Passholder" value="disney-annual-passholder" selected="selected">Disney Annual Passholder</option>&#13;
			<option label="Disney Visa Cardmember" value="disney-visa-cardmember">Disney Visa Cardmember</option>&#13;
			<option label="Florida Resident" value="florida-resident">Florida Resident</option>&#13;
			<option label="Disney+ Subscriber" value="disney-subscriber">Disney+ Subscriber</option>&#13;
			<option label="Active Retired or 100% Disabled Military" value="active-retired-or-100-disabled-military">Active Retired or 100% Disabled Military</option>&#13;
			<option label="None" value="none">None</option>&#13;
		</field>&#13;
		<field type="text" label="Do you have a specific resort in mind?" name="do-you-have-a-specific-resort-in-mind" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="How did you hear about us?" name="how-did-you-hear-about-us" className="form-control">&#13;
			<option label="Friend/Family" value="friendfamily" selected="selected">Friend/Family</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Google" value="google">Google</option>&#13;
		</field>&#13;
		<field type="text" label="If you selected friend/family who can we thank?" name="if-you-selected-friendfamily-who-can-we-thank" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Special Requests/Additional Information" name="special-requestsadditional-information" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>