<html> <body> <form-template> <fields> <field type="header" subtype="h2" label="Full name&nbsp; ( AS IT APPEARS ON YOUR DL / PASSPORT)"/> <field type="header" subtype="h2" label="Full name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" 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" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" label="State" name="address-state" subtype="text" className="form-control"/> <field type="text" label="Zip" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Cruise Information"/> <field type="date" label="Travel Date" name="travel-date" className="form-control"/> <field type="select" required="true" label="Is this a Group Booking? (more than 8)" name="is-this-a-group-booking" className="form-control"> <option label="No" value="no">No</option> <option label="Yes" value="yes">Yes</option> </field> <field type="text" required="true" label="How many adults?" name="number-of-travelers" subtype="text" className="form-control"/> <field type="checkbox-group" required="true" label="Is anyone traveling over the age of 55?" name="dates-flexible"> <option label="No" value="no">No</option> <option label="Yes" value="yes">Yes</option> </field> <field type="checkbox-group" label="Military" name="military"> <option label="Yes" value="yes">Yes</option> </field> <field type="select" required="true" label="How many children?" description="Under 18 at the time of travel" name="how-many-children" className="form-control"> <option label="None" value="none">None</option> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> <option label="4" value="4">4</option> <option label="5" value="5">5</option> <option label="more" value="more">more</option> </field> <field type="select" required="true" label="Cruise Line" name="cruise-line" className="form-control"> <option label="" value=""/> <option label="Carnival Cruise Line" value="carnival-cruise-line">Carnival Cruise Line</option> <option label="Celebrity Cruise Line" value="celebrity-cruise-line">Celebrity Cruise Line</option> <option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option> <option label="Holland America" value="holland-america">Holland America</option> <option label="Norwegian Cruise Line" value="norwegian-cruise-line">Norwegian Cruise Line</option> <option label="Royal Caribbean Cruise Line" value="royal-caribbean-cruise-line">Royal Caribbean Cruise Line</option> <option label="Princess Cruises" value="princess-cruises">Princess Cruises</option> <option label="Virgin Voyages Adult Only Cruise Line" value="virgin-voyages-adult-only-cruise-line">Virgin Voyages Adult Only Cruise Line</option> </field> <field type="clientLoyaltyPrograms" label="Loyalty Programs" 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 type="select" label="Cruise Length of Days" name="cruise-length-of-days" className="form-control"> <option label="3" value="3">3</option> <option label="4-5" value="45">4-5</option> <option label="6" value="6">6</option> <option label="7" value="7">7</option> <option label="more than 7" value="more-than-7">more than 7</option> </field> <field type="select" required="true" label="Destination" name="destination" className="form-control"> <option label="" value=""/> <option label="Alaska" value="alaska">Alaska</option> <option label="Bahamas" value="bahamas">Bahamas</option> <option label="Bermuda" value="bermuda">Bermuda</option> <option label="Canada" value="canada">Canada</option> <option label="Caribbean (Eastern or Western)" value="caribbean-eastern-or-western">Caribbean (Eastern or Western)</option> <option label="Caribbean (Southern)" value="caribbean-southern">Caribbean (Southern)</option> <option label="Europe" value="europe">Europe</option> <option label="Hawaii" value="hawaii">Hawaii</option> <option label="Mexico" value="mexico">Mexico</option> <option label="Pacific Coast" value="pacific-coast">Pacific Coast</option> <option label="Panama Canal" value="panama-canal">Panama Canal</option> <option label="Transatlantic" value="transatlantic">Transatlantic</option> <option label="Other" value="other">Other</option> </field> <field type="select" required="true" label="Departure Port" name="departure-port" className="form-control"> <option label="" value=""/> <option label="Port Canaveral, Florida" value="port-canaveral-florida">Port Canaveral, Florida</option> <option label="Miami, Florida" value="miami-florida">Miami, Florida</option> <option label="Galveston, Texas" value="galveston-texas">Galveston, Texas</option> <option label="New Orleans, Louisiana " value="new-orleans-louisiana-">New Orleans, Louisiana </option> <option label="New York, New York" value="new-york-new-york">New York, New York</option> <option label="San Diego, California " value="san-diego-california-">San Diego, California </option> <option label="Honolulu, Hawaii" value="honolulu-hawaii">Honolulu, Hawaii</option> <option label="San Juan, Puerto Rico" value="san-juan-puerto-rico">San Juan, Puerto Rico</option> <option label="Vancouver (British Columbia), Canada" value="vancouver-british-columbia-canada">Vancouver (British Columbia), Canada</option> <option label="San Francisco, California" value="san-francisco-california">San Francisco, California</option> <option label="Mobile, Alabama" value="mobile-alabama">Mobile, Alabama</option> <option label="International Port" value="international-port">International Port</option> <option label="Other" value="other">Other</option> </field> <field type="select" label="Holiday &amp; Specialty Cruise Options" name="holiday-specialty-cruise-options" className="form-control"> <option label="" value=""/> <option label="Halloween" value="halloween">Halloween</option> <option label="Thanksgiving" value="thanksgiving">Thanksgiving</option> <option label="Christmas" value="christmas">Christmas</option> <option label="New Year's Eve" value="new-years-eve">New Year's Eve</option> <option label="Marvel Day at Sea (Disney)" value="marvel-day-at-sea-disney">Marvel Day at Sea (Disney)</option> <option label="Star Wars Day at Sea (Disney)" value="star-wars-day-at-sea-disney">Star Wars Day at Sea (Disney)</option> <option label="Carnival Journeys " value="carnival-journeys-">Carnival Journeys </option> </field> <field type="select" required="true" label="Dining Preference" name="dining-preference" className="form-control"> <option label="" value=""/> <option label="Main Seating (First)" value="main-seating-first">Main Seating (First)</option> <option label="Second Seating (Late)" value="second-seating-late">Second Seating (Late)</option> <option label="Anytime Dining" value="anytime-dining">Anytime Dining</option> </field> <field type="header" subtype="h1" label="Stateroom Specifics"/> <field type="radio-group" required="true" label="Number of Staterooms Needed" name="number-of-staterooms-needed"> <option label="1" value="1">1</option> <option label="2" value="2">2</option> <option label="3" value="3">3</option> <option label="More" value="more">More</option> </field> <field type="radio-group" required="true" label="How many Guests in your Stateroom" name="how-many-guests-in-your-stateroom"> <option label="1-4" value="14">1-4</option> <option label="5 (Deluxe Family Stateroom)" value="5-deluxe-family-stateroom">5 (Deluxe Family Stateroom)</option> <option label="6-7 (Concierge-Level Suites)" value="67-conciergelevel-suites">6-7 (Concierge-Level Suites)</option> </field> <field type="select" required="true" label="Stateroom Category Preference" name="stateroom-category-preference" className="form-control"> <option label="" value=""/> <option label="Interior Room (No window or port hole)" value="interior-room-no-window-or-port-hole">Interior Room (No window or port hole)</option> <option label="Ocean View Room (Window or port hole)" value="ocean-view-room-window-or-port-hole">Ocean View Room (Window or port hole)</option> <option label="Verandah Room (Balcony)" value="verandah-room-balcony">Verandah Room (Balcony)</option> <option label="Concierge Level (Family suites with living areas)" value="concierge-level-family-suites-with-living-areas">Concierge Level (Family suites with living areas)</option> </field> <field type="select" required="true" label="Deck Location" name="deck-location" className="form-control"> <option label="" value=""/> <option label="Lower Deck" value="lower-deck">Lower Deck</option> <option label="Mid Deck" value="mid-deck">Mid Deck</option> <option label="Upper Deck" value="upper-deck">Upper Deck</option> <option label="No Preference" value="no-preference">No Preference</option> </field> <field type="select" required="true" label="Stateroom Location" name="stateroom-location" className="form-control"> <option label="" value=""/> <option label="Forward (Front)" value="forward-front">Forward (Front)</option> <option label="Middle" value="middle">Middle</option> <option label="Aft (Back)" value="aft-back">Aft (Back)</option> <option label="No Preference" value="no-preference">No Preference</option> </field> <field type="header" subtype="h1" label="Ground or Air Transportation"/> <field type="select" required="true" label="Will you need Ground Transportation?" name="will-you-need-ground-transportation" className="form-control"> <option label="" value=""/> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="select" required="true" label="Will you need air?" name="will-you-need-air" className="form-control"> <option label="" value=""/> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="text" label="What is your departure city?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/> <field type="select" label="Flight Preference" name="flight-preference" className="form-control"> <option label="" value=""/> <option label="Nonstop" value="nonstop">Nonstop</option> <option label="Cheapest" value="cheapest">Cheapest</option> </field> <field type="select" label="Class" name="class" className="form-control"> <option label="" value=""/> <option label="Economy" value="economy">Economy</option> <option label="Business class" value="business-class">Business class</option> <option label="First class" value="first-class">First class</option> </field> <field type="header" subtype="h1" label="Other"/> <field type="select" required="true" label="Travel Protection Insurance? (Highly Recommended)" name="travel-protection-insurance-highly-recommended" className="form-control"> <option label="" value=""/> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="header" subtype="h1" label="Additional Information &amp; Preferences"/> <field type="radio-group" required="true" label="What is your budget per person?" description="This just gives me a general starting point and can always be changed later." name="budget"> <option label="$400 to $700" value="400-to-700">$400 to $700</option> <option label="$700 to $1,000" value="700-to-1000">$700 to $1,000</option> <option label="$1,000 to $1,500" value="1000-to-1500">$1,000 to $1,500</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> </field> <field type="checkbox-group" label="What activities are you interested in?" description="Check all that apply" name="activity-preferences" other="true"> <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> </field> <field type="textarea" label="Special Occasion:" description="Wedding Birthday Honeymoon Anniversary Just Because Bachelor/Bachelorette Girl's Trip" name="special-occasion" className="form-control"/> <field type="checkbox-group" required="true" label="Payment Options (select the ones that would best suit you)" name="payment-terms"> <option label="Deposit with Payment Plan" value="deposit-with-payment-plan">Deposit with Payment Plan</option> <option label="Finance with UPLIFT (Book Now, Pay Later)" value="finance-with-uplift-book-now-pay-later">Finance with UPLIFT (Book Now, Pay Later)</option> <option label="Full Payment" value="full-payment">Full Payment</option> </field> <field type="text" label="Promo Code" description="Receive $100 discount off booking price!" name="discount-code" subtype="text" className="form-control"/> <field type="header" subtype="h1" label="How Did You Hear About Grace Resorts?"/> <field type="radio-group" required="true" label="Please select below" inline="true" name="please-select-below" other="true"> <option label="Social Media" value="social-media">Social Media</option> <option label="Google" value="google">Google</option> <option label="Direct Mail" value="direct-mail">Direct Mail</option> <option label="Email" value="email">Email</option> </field> </fields> </form-template> </body> </html>
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