Share your information with Melissa Gandy

Melissa Gandy

Melissa Mouse Travels

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="CRUISE QUOTE REQUEST"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#13;
		<field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-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" label="Suffix" name="suffix" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name (if different than first)" name="preferred-name-" 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" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What&#39;s your home state?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="I prefer to be contacted by:&amp;nbsp;" name="i-prefer-to-be-contacted-by-">&#13;
			<option label="Phone Call" value="phone-call">Phone Call</option>&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Any of the above is fine" value="any-of-the-above-is-fine">Any of the above is fine</option>&#13;
		</field>&#13;
		<field type="header" subtype="h2" label="Questions for your trip"/>&#13;
		<field type="checkbox-group" required="true" label="Preferred Cruise Line" name="preferred-cruise-line" other="true">&#13;
			<option label="Royal Caribbean Cruise Line" value="royal-caribbean-cruise-line">Royal Caribbean Cruise Line</option>&#13;
			<option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option>&#13;
			<option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option>&#13;
			<option label="Celebrity Cruise Line" value="celebrity-cruise-line">Celebrity Cruise Line</option>&#13;
			<option label="Princess Cruise Line" value="princess-cruise-line">Princess Cruise Line</option>&#13;
			<option label="Holland America Cruise Line" value="holland-america-cruise-line">Holland America Cruise Line</option>&#13;
			<option label="Virgin Cruise Line (Adults only) " value="virgin-cruise-line-adults-only-">Virgin Cruise Line (Adults only) </option>&#13;
			<option label="Cunard (Luxury Cruise Line) " value="cunard-luxury-cruise-line-">Cunard (Luxury Cruise Line) </option>&#13;
			<option label="Oceania Cruise Line (Adults only) " value="oceania-cruise-line-adults-only-">Oceania Cruise Line (Adults only) </option>&#13;
			<option label="Carnival Cruise Line" value="carnival-cruise-line">Carnival Cruise Line</option>&#13;
			<option label="I want a River Cruise " value="i-want-a-river-cruise-">I want a River Cruise </option>&#13;
			<option label="Not Sure/Open to suggestion" value="not-sureopen-to-suggestion">Not Sure/Open to suggestion</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="Preferred Month of Travel" name="preferred-month-of-travel" multiple="multiple" className="form-control">&#13;
			<option label="January" value="january">January</option>&#13;
			<option label="February" value="february">February</option>&#13;
			<option label="March" value="march">March</option>&#13;
			<option label="April" value="april">April</option>&#13;
			<option label="May" value="may">May</option>&#13;
			<option label="June" value="june">June</option>&#13;
			<option label="July" value="july">July</option>&#13;
			<option label="August" value="august">August</option>&#13;
			<option label="September" value="september">September</option>&#13;
			<option label="October" value="october">October</option>&#13;
			<option label="November" value="november">November</option>&#13;
			<option label="December" value="december">December</option>&#13;
		</field>&#13;
		<field type="select" required="true" label="YEAR of travel" name="year-of-travel" className="form-control">&#13;
			<option label="2026" value="2026">2026</option>&#13;
			<option label="2027" value="2027">2027</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Where do you want to cruise to?" name="text-1770395785623" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many Adults" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many Children (Under 18)" name="text-1768252856268" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ages of children at time of travel (Please make sure this is accurate - the cruise line requires proof)." name="text-1773679286089" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers? (NOT including flights)&amp;nbsp;" description="This just gives me a general starting point and can always be changed later." name="budget">&#13;
			<option label="$3,000 to $4,500" value="3000-to-4500">$3,000 to $4,500</option>&#13;
			<option label="$4,500 to $6,500" value="4500-to-6500">$4,500 to $6,500</option>&#13;
			<option label="$6,500 to $8,500" value="6500-to-8500">$6,500 to $8,500</option>&#13;
			<option label="$8,500 to $10,000" value="8500-to-10000">$8,500 to $10,000</option>&#13;
			<option label="$10,000 to $15000" value="10000-to-15000">$10,000 to $15000</option>&#13;
			<option label="$15,000-$20,000" value="1500020000">$15,000-$20,000</option>&#13;
			<option label="$20k +" value="20k-">$20k +</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Room Preferences (Interior will be the cheapest, and go up from there with suites being the most expensive)" name="room-preferences-interior-will-be-the-cheapest-and-go-up-from-there-with-suites-being-the-most-expensive">&#13;
			<option label="Interior Room" value="interior-room">Interior Room</option>&#13;
			<option label="Ocean View Room (Non working window)" value="ocean-view-room-non-working-window">Ocean View Room (Non working window)</option>&#13;
			<option label="Inside Balcony (Oversees courtyard- select ships only) " value="inside-balcony-oversees-courtyard-select-ships-only-">Inside Balcony (Oversees courtyard- select ships only) </option>&#13;
			<option label="Ocean View Balcony " value="ocean-view-balcony-">Ocean View Balcony </option>&#13;
			<option label="I need a room for 5+ (not available on all ships or sailings)" value="i-need-a-room-for-5-not-available-on-all-ships-or-sailings">I need a room for 5+ (not available on all ships or sailings)</option>&#13;
			<option label="Junior Suite" value="junior-suite">Junior Suite</option>&#13;
			<option label="Suite " value="suite-">Suite </option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What kind of vibe are you looking for?" description="Check all that apply." name="vibe-preference" other="true">&#13;
			<option label="Romantic" value="romantic">Romantic</option>&#13;
			<option label="Rest and relaxation" value="rest-and-relaxation">Rest and relaxation</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food and wine" value="food-wine">Food and wine</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true">&#13;
			<option label="Beach and water" value="beach-water">Beach and water</option>&#13;
			<option label="Gambling" value="gambling">Gambling</option>&#13;
			<option label="Scuba" value="scuba">Scuba</option>&#13;
			<option label="Adventure activities" value="adventure">Adventure activities</option>&#13;
			<option label="Golf" value="golf">Golf</option>&#13;
			<option label="Nightlife" value="nightlife">Nightlife</option>&#13;
			<option label="Arts and theater" value="art-theater">Arts and theater</option>&#13;
		</field>&#13;
		<field type="text" label="Anything you absolutely must do or see?" name="must-dos" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Do you have a preferred port you&#39;d like to leave out of?" description="Port Canaveral, Cape Liberty, Galveston, etc." name="text-1773679367948" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="What is your reason for planning this trip?&amp;nbsp;" name="text-1768253058205" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Will you be celebrating anything? (Ex. Yes, Johns 21st birthday)&amp;nbsp;" name="text-1768856798290" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="What else would you like me to know?" description="What else would you like me to know about your travelers  budget and/or travel preferences?" name="notes" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="By Filling this form out I am recognizing that I am giving Melissa Gandy with Melissa Mouse Travels and/or her employees permission to contact me.&amp;nbsp;" name="checkbox-group-1768856865328">&#13;
			<option label="Yes, I agree." value="yes-i-agree">Yes, I agree.</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>