Share your information with Kimberly Prisco

Kimberly Prisco

Travelmation LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Let&#39;s Plan Your Vacation!"/>&#13;
		<field type="paragraph" subtype="p" label="Please describe the vacation you have in mind below!"/>&#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="radio-group" required="true" label="How would you like to be contacted?" name="how-would-you-like-to-be-contacted">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Either" value="either">Either</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" required="true" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="text" label="Are your dates flexible?" description="As in - do you want to base your trip around flights? Very unsure of timeframe?" name="are-your-dates-flexible" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="How soon are you looking to book?" name="how-soon-are-you-looking-to-book">&#13;
			<option label="ASAP!" value="asap">ASAP!</option>&#13;
			<option label="Within next 7-10 days" value="within-next-710-days">Within next 7-10 days</option>&#13;
			<option label="In a few months" value="in-a-few-months">In a few months</option>&#13;
			<option label="Just considering options" value="just-considering-options">Just considering options</option>&#13;
		</field>&#13;
		<field type="text" label="What is your departure city/airport?" name="what-is-your-departure-cityairport" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many travelers?" name="how-many-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ages of minor travelers" name="birthdates-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What kind of vacation are you looking for?" name="what-kind-of-vacation-are-you-looking-for" other="true">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All-Inclusive Resort/Caribbean" value="allinclusive-resortcaribbean">All-Inclusive Resort/Caribbean</option>&#13;
			<option label="Disney Parks" value="disney-parks">Disney Parks</option>&#13;
			<option label="Universal Parks" value="universal-parks">Universal Parks</option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What travel components do you want my help with?" name="what-travel-components-do-you-want-my-help-with">&#13;
			<option label="Accomodations" value="accomodations">Accomodations</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Transportation" value="transportation">Transportation</option>&#13;
			<option label="Excursion &amp; Tours" value="excursion-tours">Excursion &amp; Tours</option>&#13;
			<option label="Insurance" value="insurance">Insurance</option>&#13;
			<option label="All the above!" value="all-the-above">All the above!</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget in total?" description="Keep flights in mind if applicable!" name="what-is-your-budget-per-traveler">&#13;
			<option label="Budget friendly: max $2K" value="budget-friendly-max-2k">Budget friendly: max $2K</option>&#13;
			<option label="Moderate: max $3K-5K" value="moderate-max-3k5k">Moderate: max $3K-5K</option>&#13;
			<option label="Little Splurge: max $5K-8K" value="little-splurge-max-5k8k">Little Splurge: max $5K-8K</option>&#13;
			<option label="Luxury: max $8K-10K" value="luxury-max-8k10k">Luxury: max $8K-10K</option>&#13;
			<option label="Let's go big: $10K+" value="lets-go-big-10k">Let's go big: $10K+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your hotel preference?" name="what-best-describes-your-hotel-preference" other="true">&#13;
			<option label="Economy" value="economy">Economy</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Luxury" value="luxury">Luxury</option>&#13;
			<option label="Boutique" value="boutique">Boutique</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Any Food Allergies/Medical Conditions to be made aware of?" name="any-food-allergiesmedical-conditions-to-be-made-aware-of" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What else would you like me to know?" placeholder="Are you celebrating anything special?" name="what-else-would-you-like-me-to-know" className="form-control"/>&#13;
		<field type="text" label="Who referred you?" placeholder="Friend/Family  Social Media... or skip if we&#39;ve worked together before!" name="who-referred-you" subtype="text" className="form-control"/>&#13;
		<field type="text" label="My current turnaround for inquiries can be 1-2 business days. Is that OK with you?" placeholder="Hopefully YES!" name="my-current-turnaround-for-inquiries-can-be-23-business-days-is-that-ok-with-you" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>