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Brittany Valenza
Coastal 2 Caribbean Travel, LLC
<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Complete the form below and an agent will be in touch.&nbsp;"/> <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="date" required="true" label="Date of Birth" name="date-1766703912455" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="textarea" label="Tell us how we can help- What do you vision for your next adventure?&nbsp;" description="Tell us about any special plans celebrations places or activities you have in mind—especially anything that’s a must-see or must-do—so we can serve you better." name="textarea-1766703139961" rows="6" className="form-control field-hidden"/> <field type="text" required="true" label="Approximately how many guests in total will be traveling?" name="number-of-travelers" subtype="text" className="form-control field-hidden"/> <field type="select" required="true" label="Do you have a preference on Trip Style?" name="select-1766704272738" multiple="multiple" className="form-control field-hidden"> <option label="Select one" value="select-one">Select one</option> <option label="Cruise" value="cruise">Cruise</option> <option label="All Inclusive Resort" value="all-inclusive-resort">All Inclusive Resort</option> <option label="Family Friendly Resorts" value="family-friendly-resorts">Family Friendly Resorts</option> <option label="Theme Park Stays & Ticketing" value="theme-park-stays-ticketing">Theme Park Stays & Ticketing</option> <option label="Guided Tours" value="guided-tours">Guided Tours</option> <option label="Beach Getaways" value="beach-getaways">Beach Getaways</option> <option label="City Escape" value="city-escape">City Escape</option> <option label="Adventure Travel (Hiking, Kayaking, Mountains, Lakes, Etc)" value="adventure-travel-hiking-kayaking-mountains-lakes-etc">Adventure Travel (Hiking, Kayaking, Mountains, Lakes, Etc)</option> <option label="Wellness/Spa or Retreats" value="wellnessspa-or-retreats">Wellness/Spa or Retreats</option> <option label="Customized Multi Destinational Trips" value="customized-multi-destinational-trips">Customized Multi Destinational Trips</option> <option label="Adults Only Resorts" value="adults-only-resorts">Adults Only Resorts</option> <option label="Hotel/Overnight Stays" value="hotelovernight-stays">Hotel/Overnight Stays</option> <option label="Other" value="other">Other</option> </field> <field type="textarea" label="Additional Traveler Details (Full Name, Date of Birth, Email, Phone Number) This information helps ensure accurate research and precise quotes as we begin planning." name="textarea-1766704858348" className="form-control field-hidden"/> <field type="text" label="Any Preference on your Departure City?" description="Where will you be traveling from? Flying/Driving from?" name="departure-city" subtype="text" className="form-control field-hidden"/> <field type="text" required="true" label="Where would you like to go? (If you're not sure just give me a few destinations you're considering.)" description="If you're not sure just give me a few destinations you're considering." placeholder="ex: Tahiti" name="destination" subtype="text" className="form-control field-hidden"/> <field type="date" required="true" label="Trip Start Date" description="This just gives me a general idea of when you like to go; it can be changed later." name="starting-at" className="form-control field-hidden"/> <field type="date" required="true" label="End my trip by the following date:" description="This just gives me an idea of the deadline to be back home by." name="date-1766704640273" className="form-control field-hidden"/> <field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible" className="field-hidden"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="radio-group" required="true" label="What is your budget for all travelers?" description="This just gives me a general starting point and can always be changed later." name="budget" other="true" className="field-hidden"> <option label="Unsure at this time, open to least expensive packaged option for the guests traveling " value="unsure-at-this-time-open-to-least-expensive-packaged-option-for-the-guests-traveling-">Unsure at this time, open to least expensive packaged option for the guests traveling </option> <option label="$1,500 to $2,500" value="1500-2500">$1,500 to $2,500</option> <option label="$2,500 to $4,500" value="2500-4500">$2,500 to $4,500</option> <option label="$4,500 to $6,500" value="4500-6500">$4,500 to $6,500</option> <option label="$6,500 to $10,000" value="6500-to-10000">$6,500 to $10,000</option> <option label="$10k to 20k" value="10k-to-20k">$10k to 20k</option> <option label="20k to 40k" value="20k-to-40k">20k to 40k</option> <option label="40k to 75k" value="40k-to-75k">40k to 75k</option> <option label="75k+" value="75k">75k+</option> </field> <field type="checkbox-group" required="true" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true" className="field-hidden"> <option label="Romantic" value="romantic">Romantic</option> <option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option> <option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option> <option label="Party" value="party">Party</option> <option label="Local culture" value="local-culture">Local culture</option> <option label="Family friendly" value="family-friendly">Family friendly</option> <option label="Food and wine" value="food-wine">Food and wine</option> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true" className="field-hidden"> <option label="Beach and water" value="beach-water">Beach and water</option> <option label="Gambling" value="gambling">Gambling</option> <option label="Scuba" value="scuba">Scuba</option> <option label="Adventure activities" value="adventure">Adventure activities</option> <option label="Golf" value="golf">Golf</option> <option label="Nightlife" value="nightlife">Nightlife</option> <option label="Arts and theater" value="art-theater">Arts and theater</option> <option label="Culinary Experiences" value="culinary-experiences">Culinary Experiences</option> </field> <field type="text" label="Is there anything else you’d consider a must-do or must-see that we haven’t covered?" name="must-dos" subtype="text" className="form-control field-hidden"/> <field type="clientLoyaltyPrograms" label="Loyalty Programs/Frequent Traveler Number" 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-hidden"/> <field type="checkbox-group" required="true" label="Are there any accessibility needs or special assistance required for anyone in your travel party?" description="If there is more than one accommodation needed, feel free to freely enter it in." inline="true" name="anyone-traveling-who-is-disabled-or-requires-specific-accommodations-or-assistance-due-to-special-needs-" other="true" className="field-hidden"> <option label="None" value="none">None</option> <option label="Wheelchair or mobility assistance" value="wheelchair-or-mobility-assistance">Wheelchair or mobility assistance</option> <option label="Accessible room / cabin required " value="accessible-room-cabin-required-">Accessible room / cabin required </option> <option label="Cognitive or developmental support (Autism, ADHD, etc)" value="cognitive-or-developmental-support-autism-adhd-etc">Cognitive or developmental support (Autism, ADHD, etc)</option> <option label="Dietary or allergy accommodations " value="dietary-or-allergy-accommodations-">Dietary or allergy accommodations </option> <option label="Limited mobility (able to walk short distances) " value="limited-mobility-able-to-walk-short-distances-">Limited mobility (able to walk short distances) </option> <option label="Scooter or mobility device " value="scooter-or-mobility-device-">Scooter or mobility device </option> <option label="Stroller-friendly accommodations" value="strollerfriendly-accommodations">Stroller-friendly accommodations</option> <option label="Hearing assistance " value="hearing-assistance-">Hearing assistance </option> <option label="Visual assistance " value="visual-assistance-">Visual assistance </option> <option label="Medical equipment (CPAP, oxygen, etc.) " value="medical-equipment-cpap-oxygen-etc-">Medical equipment (CPAP, oxygen, etc.) </option> <option label="Service animal" value="service-animal">Service animal</option> <option label="Assistance during embarkation, flights, or transfers" value="assistance-during-embarkation-flights-or-transfers">Assistance during embarkation, flights, or transfers</option> </field> <field type="header" subtype="h2" label="Passport Info" className="field-hidden"/> <field type="select" label="US Citizens for ALL Guests?&nbsp; &nbsp;*If not I will reach out to gather specifics." name="us-citizens-for-all-guests-if-not-i-will-reach-out-to-gather-specifics" className="form-control field-hidden"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="select" label="Do you have a passport?" description="Please select from the following:" name="do-you-have-a-passport" className="form-control field-hidden"> <option label="Please do not include any travel requiring a passport at this time." value="please-do-not-include-any-travel-requiring-a-passport-at-this-time">Please do not include any travel requiring a passport at this time.</option> <option label="Looking to obtain prior to trip or have one needing renewal and it is ok to consider destinations requiring this form of documentation." value="looking-to-obtain-prior-to-trip-or-have-one-needing-renewal-and-it-is-ok-to-consider-destinations-requiring-this-form-of-documentation">Looking to obtain prior to trip or have one needing renewal and it is ok to consider destinations requiring this form of documentation.</option> <option label="Already have them and they are still valid." value="already-have-them-and-they-are-still-valid">Already have them and they are still valid.</option> </field> <field type="header" subtype="h2" label="Mailing Address"/> <field type="text" required="true" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" 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 Code" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="textarea" label="How can we assist you?&nbsp;" description="Do you have any questions or concerns as we begin the planning process? Please know I’m here to support you every step of the way and readily available throughout planning and your travels." name="notes" rows="5" className="form-control"/> <field type="header" subtype="h1" label="Thank you for submitting your information. We appreciate the opportunity to assist with your travel planning and will be in touch soon. You’ve taken the first step toward an incredible experience."/> <field type="textarea" label="Any Promotional Codes you have to apply towards our services feel free to include here:" name="textarea-1766703563174" className="form-control field-hidden"/> <field type="select" required="true" label="How did you hear about Coastal to Caribbean Travel? " name="how-did-you-hear-about-coastal-to-caribbean-travel-" className="form-control"> <option label="Referred by Friend or Family" value="referred-by-friend-or-family">Referred by Friend or Family</option> <option label="Work Colleague or Business Referral" value="work-colleague-or-business-referral">Work Colleague or Business Referral</option> <option label="Search Engine ( Google, Yahoo, etc)" value="search-engine-google-yahoo-etc">Search Engine ( Google, Yahoo, etc)</option> <option label="Social Media" value="social-media">Social Media</option> <option label="Other" value="other">Other</option> </field> <field type="text" label="Referral Name so we&nbsp;can thank them for sending you our way!" name="text-1766705712888" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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