Share your information with Jenny Blazek

Jenny Blazek

Blazek Travels

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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" 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="text" label="Street Address" name="address-line-1" 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="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?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is this vacation to celebrate anything special?" name="is-this-vacation-to-celebrate-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Who all will be traveling with you? Please list all full names (including middle) and birthdates, as listed on passport." 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="At what phase of planning are you in?" name="at-what-phase-of-planning-are-you-in">&#13;
			<option label="I’m just beginning the planning process" value="im-just-beginning-the-planning-process">I’m just beginning the planning process</option>&#13;
			<option label="We have dates, but no other details confirmed" value="we-have-dates-but-no-other-details-confirmed">We have dates, but no other details confirmed</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." description="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 - $5,000" value="3000-5000">$3,000 - $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 - $15,000" value="10000-15000">$10,000 - $15,000</option>&#13;
			<option label="$15,000-$20,000" value="1500020000">$15,000-$20,000</option>&#13;
			<option label="$20,000-$30,000" value="2000030000">$20,000-$30,000</option>&#13;
			<option label="$30,000-$40,000" value="3000040000">$30,000-$40,000</option>&#13;
			<option label="$40,000-$50,000" value="4000050000">$40,000-$50,000</option>&#13;
			<option label="$50,000+" value="50000">$50,000+</option>&#13;
		</field>&#13;
		<field type="textarea" label="Will you be booking any portion of your trip with points?" description="If so  which pieces?" name="will-you-be-booking-any-portion-of-your-trip-with-points-if-so-which-pieces" className="form-control"/>&#13;
		<field type="checkbox-group" label="What travel components would you like us to assist you with?" description="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="radio-group" label="What best describes your desired accommodation style?" name="what-best-describes-your-desired-accommodation-style">&#13;
			<option label="Luxury &amp; exclusive" value="luxury-exclusive">Luxury &amp; exclusive</option>&#13;
			<option label="Boutique &amp; charming" value="boutique-charming">Boutique &amp; charming</option>&#13;
			<option label="Centrally located &amp; functional" value="centrally-located-functional" selected="selected">Centrally located &amp; functional</option>&#13;
			<option label="Large resort" value="large-resort">Large resort</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="What are your amenity “must haves”? Is there anything you would want your hotels to have such as a pool, on-site restaurant, bar, etc.?" name="what-are-your-amenity-musthaves-" className="form-control"/>&#13;
		<field type="checkbox-group" label="What options best describe your travel priorities?&amp;nbsp;" description="Check all that apply." name="what-options-best-describe-your-travel-priorities-checkbox-group">&#13;
			<option label="Local culture &amp; education" value="local-culture-education">Local culture &amp; education</option>&#13;
			<option label="Art &amp; architecture" value="art-architecture">Art &amp; architecture</option>&#13;
			<option label="Food &amp; wine" value="food-wine">Food &amp; wine</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
			<option label="Dramatic views &amp; landscapes" value="dramatic-views-landscapes">Dramatic views &amp; landscapes</option>&#13;
			<option label="Spa &amp; wellness" value="spa-wellness">Spa &amp; wellness</option>&#13;
			<option label="Rest &amp; relaxation" value="rest-relaxation">Rest &amp; relaxation</option>&#13;
		</field>&#13;
		<field type="textarea" label="What else would you like me to know about your ideal vacation?&amp;nbsp;" name="describe-your-vision-for-your-ideal-vacation" className="form-control"/>&#13;
		<field type="text" label="Do any travelers have allergies that I should be aware of? I will do my best to accommodate." name="do-any-travelers-have-allergies-that-i-should-be-aware-of-" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Who can I thank for referring you to 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 company newsletter?&amp;nbsp;" name="would-you-like-to-be-subscribed-to-our-newsletter-and-travel-updates" className="form-control">&#13;
			<option label="Yes- sign me up!" value="yes-sign-me-up">Yes- sign me up!</option>&#13;
			<option label="No, I get too many emails" value="no-i-get-too-many-emails">No, I get too many emails</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 AGENCY_NAME"/>&#13;
		<field type="header" subtype="h1" label="LET&#39;S REVIEW THE FINE PRINT"/>&#13;
		<field type="checkbox-group" required="true" label="Please note that some of our proposals come from suppliers who provide bundled rates without breaking down individual components. This practice protects our valued partners who may have confidential, contracted rates from local vendors, and creates a seamless and holistic approach to your travel plans. Do you agree and understand that your proposal will come as one packaged rate and itemized pricing will not be available?" name="please-note-that-some-of-our-proposals-come-from-suppliers-who-provide-bundled-rates-without-breaking-down-individual-components-this-practice-protects-our-valued-partners-who-may-have-confidential-contracted-rates-from-local-vendors-and-creates-a-seamless-and-holistic-approach-to-your-travel-plans-do-you-agree-and-understand-that-your-proposal-will-come-as-one-packaged-rate-and-itemized-pricing-will-not-be-available">&#13;
			<option label="Yes, I understand and agree" value="yes-i-understand-and-agree">Yes, I understand and agree</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Please understand that while planning your trip, we will primarily be in contact via email or scheduled phone calls. This approach provides you with the best level of service while ensuring that no important information is overlooked. We strongly discourage questions via text message in order to maintain accuracy and clarity while we plan your trip. In advance of your departure date, we will provide you the best local contact information for prompt assistance after business hours. Unscheduled calls and texts are of course available to you for any in-travel emergencies that arise." name="please-understand-that-while-planning-your-trip-we-will-primarily-be-in-contact-via-email-or-scheduled-phone-calls-this-approach-provides-you-with-the-best-level-of-service-while-ensuring-that-no-important-information-is-overlooked-we-strongly-discourage-questions-via-text-message-in-order-to-maintain-accuracy-and-clarity-while-we-plan-your-trip-in-advance-of-your-departure-date-we-will-provide-you-the-best-local-contact-information-for-prompt-assistance-after-business-hours-unscheduled-calls-and-texts-are-of-course-available-to-you-for-any-intravel-emergencies-that-arise">&#13;
			<option label="Yes, I understand and agree" value="yes-i-understand-and-agree">Yes, I understand and agree</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Please be aware that there may be a planning fee associated with the creation of your personalized itinerary. During our complimentary intake call, we&#39;ll discuss your travel goals and provide you with a detailed understanding of any associated fees based upon the unique aspects and complexities of your trip request." name="please-be-aware-that-there-may-be-a-planning-fee-associated-with-the-creation-of-your-personalized-itinerary-during-our-complimentary-intake-call-well-discuss-your-travel-goals-and-provide-you-with-a-detailed-understanding-of-any-associated-fees-based-upon-the-unique-aspects-and-complexities-of-your-trip-request">&#13;
			<option label="Yes, I understand and agree" value="yes-i-understand-and-agree">Yes, I understand and agree</option>&#13;
		</field>&#13;
	</fields>&#13;
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