Share your information with Simone McFarlane-Tucker

Simone McFarlane-Tucker

Glamour Tag Consultation Services, LLC

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    <form-template>&#13;
	<fields><field type="text" subtype="text" required="true" label="First name" className="form-control" name="first-name"></field><field type="text" subtype="text" required="true" label="Last name" className="form-control" name="last-name"></field><field type="text" subtype="text" required="true" label="Email" className="form-control" name="email"></field>&#13;
		<field type="header" subtype="h1" label="Applicant Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Full Name (as it appears on legal documents):&amp;nbsp;" name="full-name-as-it-appears-on-legal-documents-" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Date of Birth:&amp;nbsp;" name="date-of-birth-" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone Number:&amp;nbsp;" name="phone-number-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email Address:&amp;nbsp;" name="email-address-" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Mailing Address: (Street, City, State, ZIP)&amp;nbsp;" name="mailing-address-street-city-state-zip-" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Passport Type &amp;amp; Service Needed&amp;nbsp;"/>&#13;
		<field type="checkbox-group" required="true" label="Is this a first-time passport application or a renewal?&amp;nbsp;" name="is-this-a-firsttime-passport-application-or-a-renewal-">&#13;
			<option label="First-time Passport" value="firsttime-passport">First-time Passport</option>&#13;
			<option label="Renewal" value="renewal">Renewal</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Number of Applicants:&amp;nbsp;" name="number-of-applicants-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="For additional applicants, please provide their full names and dates of birth:&amp;nbsp;" name="for-additional-applicants-please-provide-their-full-names-and-dates-of-birth-" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Processing &amp;amp; Delivery Preferences&amp;nbsp;"/>&#13;
		<field type="radio-group" required="true" label="Do you need expedited processing?" name="do-you-need-expedited-processing">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do you need assistance with passport photos?&amp;nbsp;" name="do-you-need-assistance-with-passport-photos-">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No, I already have passport-compliant photos" value="no-i-already-have-passportcompliant-photos">No, I already have passport-compliant photos</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Do you require assistance with name changes, lost/stolen passports, or special circumstances?&amp;nbsp;" name="do-you-require-assistance-with-name-changes-loststolen-passports-or-special-circumstances-">&#13;
			<option label="Yes (please specify)" value="yes-please-specify" selected="selected">Yes (please specify)</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Travel Plans&amp;nbsp;"/>&#13;
		<field type="checkbox-group" label="Do you have upcoming travel plans?&amp;nbsp;" name="do-you-have-upcoming-travel-plans-">&#13;
			<option label="Yes (please provide destination &amp; travel date)" value="yes-please-provide-destination-travel-date" selected="selected">Yes (please provide destination &amp; travel date)</option>&#13;
			<option label="No, just getting my passport ready" value="no-just-getting-my-passport-ready">No, just getting my passport ready</option>&#13;
		</field>&#13;
		<field type="textarea" required="true" label="Provide upcoming travel plans here if applicable.&amp;nbsp;" name="provide-upcoming-travel-plans-here-if-applicable-" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Would you like assistance with visa applications if needed for your destination?&amp;nbsp;" name="would-you-like-assistance-with-visa-applications-if-needed-for-your-destination-">&#13;
			<option label="Yes" value="yes" selected="selected">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Payment &amp;amp; Additional Services&amp;nbsp;"/>&#13;
		<field type="checkbox-group" label="Payment Method:&amp;nbsp;" toggle="true" name="payment-method-" other="true">&#13;
			<option label="Credit/Debit Card" value="creditdebit-card">Credit/Debit Card</option>&#13;
			<option label="PayPal" value="paypal">PayPal</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Would you like additional travel services such as flights, accommodations, or travel insurance?&amp;nbsp;" toggle="true" name="would-you-like-additional-travel-services-such-as-flights-accommodations-or-travel-insurance-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Additional Notes or Special Requests:&amp;nbsp;"/>&#13;
		<field type="textarea" required="true" label="Is there anything else we should know to assist you better?&amp;nbsp;" name="is-there-anything-else-we-should-know-to-assist-you-better-" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="How did you find GLAMour Tag? IF REFERRED BY A FRIEND/FAMILY/BUSINESS, CHECK THE OTHER SECTION AND PUT THEIR NAME IN THEIR NAME IN THEIR OTHER SECTION." name="how-did-you-find-glamour-tag-if-referred-by-a-friendfamilybusiness-check-the-other-section-and-put-their-name-in-their-name-in-their-other-section">&#13;
			<option label="Friend/Family/Business" value="friendfamilybusiness" selected="selected">Friend/Family/Business</option>&#13;
			<option label="Google" value="google">Google</option>&#13;
			<option label="Networking Event" value="networking-event">Networking Event</option>&#13;
			<option label="Bing" value="bing">Bing</option>&#13;
			<option label="Social Media" value="social-media">Social Media</option>&#13;
		</field>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>