Share your information with Dolly & Brandon

Dolly & Brandon

Heartbeats for Travel

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Primary Traveler Information"/>&#13;
		<field type="radio-group" required="true" label="Gender" name="gender">&#13;
			<option label="F" value="female">F</option>&#13;
			<option label="M" value="male">M</option>&#13;
			<option label="X" value="other">X</option>&#13;
		</field>&#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="date" required="true" label="Birthday" name="birthday" 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="State Of Residence?" name="state-of-residence" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="VIFP Number (For Carnival Past Guest)&amp;nbsp;"/>&#13;
		<field type="clientLoyaltyPrograms" label="VIFP Number (For Carnival Past Guest)" description="VIFP Number (For Carnival Past Guest)" 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"/>&#13;
		<field type="radio-group" required="true" label="First Time Cruiser?" name="first-time-cruiser">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you celebrating a special occasion for this cruise?" name="are-you-celebrating-a-special-occasion-for-this-cruise" other="true">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Honeymoon" value="honeymoon">Honeymoon</option>&#13;
			<option label="Family Getaway" value="family-getaway">Family Getaway</option>&#13;
			<option label="Fun Getaway" value="fun-getaway">Fun Getaway</option>&#13;
			<option label="Retirement Celebration" value="retirement-celebration">Retirement Celebration</option>&#13;
		</field>&#13;
		<field type="text" label="SAIL TO" placeholder="Ex: The Bahamas  The Caribbean" name="sail-to" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="SAIL FROM" inline="true" name="sail-from">&#13;
			<option label="Baltimore, MD" value="baltimore-md">Baltimore, MD</option>&#13;
			<option label="Charleston, SC" value="charleston-sc">Charleston, SC</option>&#13;
			<option label="Galveston, TX" value="galveston-tx">Galveston, TX</option>&#13;
			<option label="Jacksonville, FL" value="jacksonville-fl">Jacksonville, FL</option>&#13;
			<option label="Los Angeles, CA" value="los-angeles-ca">Los Angeles, CA</option>&#13;
			<option label="Miami, FL" value="miami-fl">Miami, FL</option>&#13;
			<option label="Mobile, AL" value="mobile-al">Mobile, AL</option>&#13;
			<option label="New Orleans, LA" value="new-orleans-la">New Orleans, LA</option>&#13;
			<option label="New York, NY" value="new-york-ny">New York, NY</option>&#13;
			<option label="Norfolk, VA" value="norfolk-va">Norfolk, VA</option>&#13;
			<option label="Orlando, FL" value="orlando-fl">Orlando, FL</option>&#13;
			<option label="San Diego, CA" value="san-diego-ca">San Diego, CA</option>&#13;
			<option label="San Francisco, CA" value="san-francisco-ca">San Francisco, CA</option>&#13;
			<option label="Seattle, WA" value="seattle-wa">Seattle, WA</option>&#13;
			<option label="Tampa, FL" value="tampa-fl">Tampa, FL</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="DATES" placeholder="Ex: April 2023" name="dates" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="DURATION" name="duration">&#13;
			<option label="2 - 5 DAYS" value="2-5-days">2 - 5 DAYS</option>&#13;
			<option label="6 - 9 DAYS" value="6-9-days">6 - 9 DAYS</option>&#13;
			<option label="10+ DAYS" value="10-days">10+ DAYS</option>&#13;
		</field>&#13;
		<field type="select" label="Choose Your Ship(s)" name="choose-your-ships" multiple="multiple" className="form-control">&#13;
			<option label="Carnival Jubilee" value="carnival-jubilee">Carnival Jubilee</option>&#13;
			<option label="Carnival Firenze" value="carnival-firenze">Carnival Firenze</option>&#13;
			<option label="Carnival Venezia" value="carnival-venezia">Carnival Venezia</option>&#13;
			<option label="Carnival Celebration" value="carnival-celebration">Carnival Celebration</option>&#13;
			<option label="Carnival Luminosa" value="carnival-luminosa">Carnival Luminosa</option>&#13;
			<option label="Carnival Glory" value="carnival-glory">Carnival Glory</option>&#13;
			<option label="Mardi Gras" value="mardi-gras">Mardi Gras</option>&#13;
			<option label="Carnival Radiance" value="carnival-radiance">Carnival Radiance</option>&#13;
			<option label="Carnival Panorama" value="carnival-panorama">Carnival Panorama</option>&#13;
			<option label="Carnival Spirit" value="carnival-spirit">Carnival Spirit</option>&#13;
			<option label="Carnival Horizon" value="carnival-horizon">Carnival Horizon</option>&#13;
			<option label="Carnival Sunrise" value="carnival-sunrise">Carnival Sunrise</option>&#13;
			<option label="Carnival Miracle" value="carnival-miracle">Carnival Miracle</option>&#13;
			<option label="Carnival Vista" value="carnival-vista">Carnival Vista</option>&#13;
			<option label="Carnival Magic" value="carnival-magic">Carnival Magic</option>&#13;
			<option label="Carnival Breeze" value="carnival-breeze">Carnival Breeze</option>&#13;
			<option label="Carnival Freedom" value="carnival-freedom">Carnival Freedom</option>&#13;
			<option label="Carnival Legend" value="carnival-legend">Carnival Legend</option>&#13;
			<option label="Carnival Paradise" value="carnival-paradise">Carnival Paradise</option>&#13;
			<option label="Carnival Elation" value="carnival-elation">Carnival Elation</option>&#13;
			<option label="Carnival Sunshine" value="carnival-sunshine">Carnival Sunshine</option>&#13;
			<option label="Carnival Dream" value="carnival-dream">Carnival Dream</option>&#13;
			<option label="Carnival Valor" value="carnival-valor">Carnival Valor</option>&#13;
			<option label="Carnival Liberty" value="carnival-liberty">Carnival Liberty</option>&#13;
			<option label="Carnival Conquest" value="carnival-conquest">Carnival Conquest</option>&#13;
			<option label="Carnival Pride" value="carnival-pride">Carnival Pride</option>&#13;
			<option label="Carnival Splendor" value="carnival-splendor">Carnival Splendor</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="CABIN TYPE" description="Ex. Inside (No Window)  Ocean View (Close to Water)  Balcony" name="cabin-type">&#13;
			<option label="Inside Cabin" value="inside-cabin">Inside Cabin</option>&#13;
			<option label="Oceanview Cabin" value="oceanview-cabin">Oceanview Cabin</option>&#13;
			<option label="Balcony Cabin" value="balcony-cabin">Balcony Cabin</option>&#13;
			<option label="Suite" value="suite">Suite</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Would you like to apply for Uplift financing with $0 down + interest free?" name="would-you-like-to-use-uplift-financing-with-0-down-interest-free-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="radio-group" label="How did you hear about us?" name="how-did-you-hear-about-us" other="true">&#13;
			<option label="Youtube" value="youtube">Youtube</option>&#13;
			<option label="Facebook" value="facebook">Facebook</option>&#13;
			<option label="Instagram" value="instagram">Instagram</option>&#13;
			<option label="Google" value="google">Google</option>&#13;
		</field>&#13;
		<field type="textarea" label="Message" name="message" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="TRAVEL INSURANCE"/>&#13;
		<field type="paragraph" subtype="p" label="By signing below, I understand that declining travel insurance could result in the loss of my travel cost and/or require more money to correct the situation. I also acknowledge that without insurance, there may be no way to recoup any losses, costs or expenses incurred."/>&#13;
		<field type="radio-group" required="true" label="Please Choose" name="please-choose">&#13;
			<option label="I ACCEPT Travel Insurance" value="i-accept-travel-insurance">I ACCEPT Travel Insurance</option>&#13;
			<option label="I DECLINE Travel Insurance. I understand that this could result in the loss of ALL of my travel costs." value="i-decline-travel-insurance-i-understand-that-this-could-result-in-the-loss-of-all-of-my-travel-costs">I DECLINE Travel Insurance. I understand that this could result in the loss of ALL of my travel costs.</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>

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