Share your information with Melissa Constien

Melissa Constien

TRAVELMATION - MELISSA CONSTIEN

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Walt Disney World Quote Request&amp;nbsp;"/>&#13;
		<field type="header" subtype="h1" label="Contact Information"/>&#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" 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="checkbox-group" required="true" label="Preferred Method of Contact" inline="true" name="preferred-method-of-contact">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Any " value="any-">Any </option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Your Travel Plans"/>&#13;
		<field type="text" label="What is your departure city/airport?" description="Where will you be flying from?" name="departure-city" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="When would you like to travel?" description="Please be specific. If you&#39;re not 100% sure  kindly include the month and year." name="when-would-you-like-to-travel" className="form-control"/>&#13;
		<field type="checkbox-group" label="Are your dates flexible?" name="dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How soon are you looking to book?&amp;nbsp;" name="how-soon-are-you-looking-to-book-">&#13;
			<option label="Today" value="today">Today</option>&#13;
			<option label="Within next 7 - 10 days" value="within-next-7-10-days">Within next 7 - 10 days</option>&#13;
			<option label="In a few months" value="in-a-few-months">In a few months</option>&#13;
			<option label="Just considering options" value="just-considering-options">Just considering options</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Are you or a member of your party a member of the United States Military?&amp;nbsp;" name="checkbox-group-1733276375009">&#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="How many adults?" name="number-of-travelers" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many kids?" name="text-1733276803404" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Ages of children&amp;nbsp;" name="text-1733276065460" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="How many rooms do you need?" name="how-many-rooms-do-you-need" other="true">&#13;
			<option label="1" value="1">1</option>&#13;
			<option label="2" value="2">2</option>&#13;
			<option label="3" value="3">3</option>&#13;
		</field>&#13;
		<field type="textarea" label="First/Last Name as on Passport, Birthdate, Gender of entire party" name="firstlast-name-birthdate-gender" className="form-control"/>&#13;
		<field type="checkbox-group" label="Which of the following will you need in addition to your WDW vacation?" name="checkbox-group-1733276596347" other="true">&#13;
			<option label="Hotel" value="hotel">Hotel</option>&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Ground Transportation/Shuttles" value="ground-transportationshuttles">Ground Transportation/Shuttles</option>&#13;
			<option label="Rental Car" value="rental-car">Rental Car</option>&#13;
			<option label="Excursions" value="excursions">Excursions</option>&#13;
			<option label="Equipment (baby gear, ADA gear)" value="equipment-baby-gear-ada-gear">Equipment (baby gear, ADA gear)</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Disney Specific Information"/>&#13;
		<field type="checkbox-group" required="true" label="Which of the following parks are you interesting in visiting?" name="hotel-amenity-musthaves">&#13;
			<option label="Magic Kingdom" value="magic-kingdom">Magic Kingdom</option>&#13;
			<option label="Epcot" value="epcot">Epcot</option>&#13;
			<option label="Hollywood Studios" value="hollywood-studios">Hollywood Studios</option>&#13;
			<option label="Animal Kingdom" value="animal-kingdom">Animal Kingdom</option>&#13;
			<option label="All  Parks - MK, Epcot, HS &amp; AK" value="all-parks-mk-epcot-hs-ak">All  Parks - MK, Epcot, HS &amp; AK</option>&#13;
			<option label=" Blizzard Beach/Typhoon Lagoon, Wide World of Sports, or Golf/Mini Golf" value="-blizzard-beachtyphoon-lagoon-wide-world-of-sports-or-golfmini-golf"> Blizzard Beach/Typhoon Lagoon, Wide World of Sports, or Golf/Mini Golf</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="How many days of tickets are you interested in?&amp;nbsp;" name="text-1733270678596" subtype="text" className="form-control"/>&#13;
		<field type="checkbox-group" required="true" label="Which type of ticket are you interested in?&amp;nbsp;" name="checkbox-group-1733276988423">&#13;
			<option label="Base Ticket - One Park per Day" value="base-ticket-one-park-per-day">Base Ticket - One Park per Day</option>&#13;
			<option label="Park Hopper - Multiple Parks per Day" value="park-hopper-multiple-parks-per-day">Park Hopper - Multiple Parks per Day</option>&#13;
			<option label="Water Park Option" value="water-park-option">Water Park Option</option>&#13;
			<option label="Unsure at this time" value="unsure-at-this-time">Unsure at this time</option>&#13;
		</field>&#13;
		<field type="checkbox-group" required="true" label="Please select any extras you are interested in:&amp;nbsp;" name="checkbox-group-1733277102704">&#13;
			<option label="Memory Maker (Photo Package)" value="memory-maker-photo-package">Memory Maker (Photo Package)</option>&#13;
			<option label="Dining Plan" value="dining-plan">Dining Plan</option>&#13;
			<option label="Bibbidy Bobbidy Boutique" value="bibbidy-bobbidy-boutique">Bibbidy Bobbidy Boutique</option>&#13;
			<option label="Star Wars Droid Depot" value="star-wars-droid-depot">Star Wars Droid Depot</option>&#13;
			<option label="Star Wars Lightsaber Build" value="star-wars-lightsaber-build">Star Wars Lightsaber Build</option>&#13;
			<option label="Magic Bands" value="magic-bands">Magic Bands</option>&#13;
			<option label="Special Party/Event Tickets" value="special-partyevent-tickets">Special Party/Event Tickets</option>&#13;
		</field>&#13;
		<field type="text" required="true" label="Are you wanting to book any sit down meals or character meals? Please specify which ones and how many!&amp;nbsp;" name="text-1733277194760" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Do you have an idea of Resorts that interest you? If so, which ones? Would you like a single resort or a split-stay between two or more resorts? It&#39;s okay if you don&#39;t know!" name="text-1733277951412" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Which Resort Category will best suit your needs?&amp;nbsp;" name="hotel-preference" other="true">&#13;
			<option label="Value" value="value">Value</option>&#13;
			<option label="Moderate" value="moderate">Moderate</option>&#13;
			<option label="Deluxe" value="deluxe">Deluxe</option>&#13;
			<option label="Offsite" value="offsite">Offsite</option>&#13;
			<option label="Unsure, please help us decide!" value="unsure-please-help-us-decide">Unsure, please help us decide!</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Budget"/>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers, including flights?" description="This just gives me a general starting point and can always be changed later. I will do my best to search for the most value for your price point  but I ask your expectations to be realistic to match your budget." name="budget" other="true">&#13;
			<option label="$1,500 to $3,500" value="1500-to-3500">$1,500 to $3,500</option>&#13;
			<option label="$3,500 to $6,000" value="3500-to-6000">$3,500 to $6,000</option>&#13;
			<option label="$6,000 to $9,000" value="6000-to-9000">$6,000 to $9,000</option>&#13;
			<option label="$9,000 to $15,000" value="9000-to-15000">$9,000 to $15,000</option>&#13;
			<option label="$15,000 to $25,000" value="15000-to-25000">$15,000 to $25,000</option>&#13;
			<option label="$25,000+" value="25000">$25,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What best describes your price point?" name="what-best-describes-your-price-point">&#13;
			<option label="I am all about quality, price is not a concern" value="i-am-all-about-quality-price-is-not-a-concern">I am all about quality, price is not a concern</option>&#13;
			<option label="I am looking for the most economical deal" value="i-am-looking-for-the-most-economical-deal">I am looking for the most economical deal</option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Other Information"/>&#13;
		<field type="radio-group" label="Are you interested in travel insurance?&amp;nbsp;" name="are-you-interested-in-travel-insurance-">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
			<option label="Maybe" value="maybe">Maybe</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Will you be celebrating an occasion?&amp;nbsp;" name="radio-group-1733276473119">&#13;
			<option label="Birthday" value="birthday">Birthday</option>&#13;
			<option label="Anniversary" value="anniversary">Anniversary</option>&#13;
			<option label="Wedding" value="wedding">Wedding</option>&#13;
			<option label="First Visit" value="first-visit">First Visit</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="textarea" label="Who can I thank for referring you to me?" name="who-can-i-thank-for-referring-you-to-me" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Any Accessibility Concerns/Food Allergies/Medical Conditions/Extra Needs to be made aware of?&amp;nbsp;" description="(Diabetic   Autism Spectrum   Wheelchair   Gluten-free  Etc.)" name="any-food-allergiesmedical-conditions-to-be-made-aware-of-" 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;
	</fields>&#13;
</form-template>
  </body>
</html>