Share your information with Karlee Kaczmarczyk

Karlee Kaczmarczyk

Triple the Magic Travel Co.

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Triple the Magic Travel Co."/>&#13;
		<field type="header" subtype="h1" label="Please complete the form to receive a custom vacation quote."/>&#13;
		<field required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h2" label="Full name"/>&#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" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Where would you like to go?" name="checkbox-group-1765733657907">&#13;
			<option label="Walt Disney World" value="walt-disney-world">Walt Disney World</option>&#13;
			<option label="Disneyland" value="disneyland">Disneyland</option>&#13;
			<option label="Disney Cruise " value="disney-cruise-">Disney Cruise </option>&#13;
			<option label="Aulani" value="aulani">Aulani</option>&#13;
			<option label="Adventures by Disney" value="adventures-by-disney">Adventures by Disney</option>&#13;
			<option label="Universal Orlando" value="universal-orlando">Universal Orlando</option>&#13;
			<option label="Universal Hollywood" value="universal-hollywood">Universal Hollywood</option>&#13;
			<option label="All-Inclusive" value="allinclusive">All-Inclusive</option>&#13;
			<option label="Cruise (Royal Caribbean, Norwegian, Princess, etc)" value="cruise-royal-caribbean-norwegian-princess-etc">Cruise (Royal Caribbean, Norwegian, Princess, etc)</option>&#13;
		</field>&#13;
		<field type="text" label="Are you currently working with an agent or want to request a specific agent?" name="are-you-currently-working-with-an-agent-or-want-to-request-a-specific-agent" subtype="text" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>