<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="PRICING REQUEST FOR CANADA &amp; NEW ENGLAND : Unesco Sites &amp; Quebecois Nights"/> <field type="paragraph" subtype="p" label="Welcome to the next step in planning your trip! I would like to make your vacation hassle free and finalizing accurate paperwork is an essential step. In an effort to ensure proper travel documentation requirements are met and security issues are avoided; please complete the following form fully and accurately. All submitted information is secure, properly protected, and used exclusively for your upcoming reservation."/> <field type="text" required="true" label="First name" name="first-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" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="text" required="true" label="Street Address or PO Box" name="address-line-1" subtype="text" className="form-control"/> <field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="clientLoyaltyPrograms" label="If you have sailed Holland America Cruises before, please provide your loyalty number.&nbsp; Also share TSA and frequent flyer numbers." name="loyalty-program" loyalty-program-note="*** This field allows your client to enter multiple loyalty program numbers (you only need one of these per form template) ***" className="form-control"/> <field type="paragraph" subtype="p" label="CABIN CATEGORY PREFERRED We have several different room categories in the group with confirmed rates as seen below. If you would like to have a different category, please describe and I will do my best to see what is available."/> <field type="checkbox-group" required="true" label="CABIN CHOICE" description="Once I receive your request I will send over a confirmation showing complete pricing using whatever promo applies for first and second passengers in the cabin. Third and/or fourth passengers will be reduced amount varies by cabin category. *THERE WILL BE HIGHER RATE IF JUST ONE PERSON IN CABIN" name="cabin-choice"> <option label="J - Interior Room " value="j-interior-room-">J - Interior Room </option> <option label="D - Ocean View" value="d-ocean-view">D - Ocean View</option> <option label="VC - Verandah " value="vc-verandah-">VC - Verandah </option> <option label="VB - Verandah" value="vb-verandah">VB - Verandah</option> <option label="VA - Verandah" value="va-verandah">VA - Verandah</option> </field> <field type="textarea" label="Additional travelers full legal name and birthdays" name="additional-travelers-full-legal-name-and-birthdays" className="form-control"/> <field type="checkbox-group" required="true" label="Holland offers their Have it All Package that generally includes perks such as Shore Ex credit, Premium Beverage Package, Premium Wifi, Gratuities&nbsp;" name="celebrity-offers-upgrades-that-include-certain-perks-please-select-whichever-you-would-like-to-include"> <option label="Please Include" value="please-include">Please Include</option> <option label="We prefer not to add at this time." value="we-prefer-not-to-add-at-this-time">We prefer not to add at this time.</option> </field> <field type="checkbox-group" required="true" label="Holland offers Cancellation Protection starting at $329 per person that must be purchased by final payment" name="holland-offers-cancellation-protection-starting-at-429-per-person-that-must-be-purchased-by-final-payment"> <option label="Please add to standard protection to cover just the cruise" value="please-add-to-standard-protection-to-cover-just-the-cruise">Please add to standard protection to cover just the cruise</option> <option label="Please add platinum protection for a bit more that covers the cruise and medical" value="please-add-platinum-protection-for-a-bit-more-that-covers-the-cruise-and-medical">Please add platinum protection for a bit more that covers the cruise and medical</option> <option label="We decline to purchase travel protection" value="we-decline-to-purchase-travel-protection">We decline to purchase travel protection</option> </field> <field type="date" label="Will you be celebrating an anniversary or other special date while on the trip? And on which date?" name="wedding-anniversary" className="form-control"/> <field type="text" label="Preferred Airport" name="preferred-airport" subtype="text" className="form-control"/> <field type="checkbox-group" label="Bedding Preference:" name="bedding-preference"> <option label="Beds apart" value="beds-apart">Beds apart</option> <option label="Beds together" value="beds-together">Beds together</option> </field> <field type="text" label="Specialty Meal preference" name="meal-preference" subtype="text" className="form-control"/> <field type="textarea" label="Comments/Questions:" name="commentsquestions" className="form-control"/> </fields> </form-template> </body> </html>
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