Share your information with Humberto Roman

Humberto Roman

Roman Ortiz Travel Partners

<html>
  <body>
    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="paragraph" subtype="p" label="This short form helps us create personalized travel options for you. No payment is required. Our planning service is complimentary."/>&#13;
		<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 required="true"  type="text" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" description="(optional but recommended)" placeholder="xxx-xxx-xxxx" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="We may use text or email to send your options faster."/>&#13;
		<field type="header" subtype="h1" label="TRAVEL DETAILS (the essentials)"/>&#13;
		<field type="text" required="true" label="Place of Departure (City &amp;amp; State)" placeholder="ex: Arlington  TX" name="destination" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Destination" description="Select your Desired Destination" name="how-did-you-hear-from-us">&#13;
			<option label="Mexican Caribbean (Cancun, Tulum, Playa del Carmen, Riviera Maya)" value="mexican-caribbean-cancun-tulum-playa-del-carmen-riviera-maya">Mexican Caribbean (Cancun, Tulum, Playa del Carmen, Riviera Maya)</option>&#13;
			<option label="Caribbean (Punta Cana, Puerto Rico, Turcs &amp; Caico Islands, Jamaica,  The Bahamas)" value="caribbean-punta-cana-puerto-rico-turcs-caico-islands-jamaica-the-bahamas">Caribbean (Punta Cana, Puerto Rico, Turcs &amp; Caico Islands, Jamaica,  The Bahamas)</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="Not sure yet (we can help)" value="not-sure-yet-we-can-help">Not sure yet (we can help)</option>&#13;
		</field>&#13;
		<field type="text" label="Preferred Resort or Cruise (optional)" placeholder="(if you have one in mind)" name="text-1766427677824" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Departure Date" name="starting-at" className="form-control"/>&#13;
		<field type="date" required="true" label="Return Date" name="ending-at" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="checkbox-group-1767898428700">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="select" label="Number of Days Desired for Vacation" placeholder="Are your dates flexible?" name="select-1766425416659" className="form-control">&#13;
			<option label="Select your Number of Days Desired" value="select-your-number-of-days-desired">Select your Number of Days Desired</option>&#13;
			<option label="3-4" value="34">3-4</option>&#13;
			<option label="5-6" value="56">5-6</option>&#13;
			<option label="7-9" value="79">7-9</option>&#13;
			<option label="10+" value="10">10+</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Total Number of Travelers" placeholder="Adults and Children (if any)" name="text-1767032640787" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="WHAT SHOULD WE INCLUDE?"/>&#13;
		<field type="checkbox-group" required="true" label="Select what you want us to plan (choose all that apply):" name="checkbox-group-1766433128454">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Hotel / Resort" value="hotel-resort">Hotel / Resort</option>&#13;
			<option label="Airport Transportation" value="airport-transportation">Airport Transportation</option>&#13;
			<option label="Activities / Excursions" value="activities-excursions">Activities / Excursions</option>&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="PAYMENT &amp;amp; EXTRAS (optional)"/>&#13;
		<field type="paragraph" subtype="p" label="Included at no cost: ✓ Free vacation planning ✓ Interest-free payment plan setup"/>&#13;
		<field type="checkbox-group" label="Optional add-ons (you can decide later):" name="checkbox-group-1766433298002">&#13;
			<option label="Full day-by-day itinerary" value="full-daybyday-itinerary">Full day-by-day itinerary</option>&#13;
			<option label="Travel insurance (quoted separately)" value="travel-insurance-quoted-separately">Travel insurance (quoted separately)</option>&#13;
			<option label="On-trip assistance" value="ontrip-assistance">On-trip assistance</option>&#13;
		</field>&#13;
		<field type="header" subtype="h3" label="BUDGET &amp;amp; READINESS (very important)"/>&#13;
		<field type="select" required="true" label="Estimated total budget for this trip" name="what-is-your-budget-for-your-vacation" className="form-control">&#13;
			<option label="Select your ideal budget" value="select-your-ideal-budget">Select your ideal budget</option>&#13;
			<option label="Under $3,000" value="under-3000">Under $3,000</option>&#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+" value="7000">$7,000+</option>&#13;
			<option label="Not sure — want guidance" value="not-sure-want-guidance">Not sure — want guidance</option>&#13;
		</field>&#13;
		<field type="select" label="If the right option fits your budget, are you ready to move forward?" name="select-1766432952407" className="form-control">&#13;
			<option label="Select your choice" value="select-your-choice">Select your choice</option>&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="Maybe — still comparing" value="maybe-still-comparing">Maybe — still comparing</option>&#13;
			<option label="Just researching" value="just-researching">Just researching</option>&#13;
		</field>&#13;
		<field type="select" label="How did you hear about us?" name="select-1766432685155" className="form-control">&#13;
			<option label="Check all that apply" value="check-all-that-apply">Check all that apply</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Yelp" value="yelp">Yelp</option>&#13;
			<option label="Tik Tok" value="tik-tok">Tik Tok</option>&#13;
			<option label="Google Search" value="google-search">Google Search</option>&#13;
			<option label="Referral" value="referral">Referral</option>&#13;
		</field>&#13;
		<field type="text" label="Anything we should know?" placeholder="(example: celebrating something, traveling with kids, preferred vibe, must-haves)" name="text-1767899208001" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>