Share your information with Casey Zenner

Casey Zenner

Magical Moments Vacations

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h1" label="Contact &amp;amp; Basic Info&amp;nbsp;"/>&#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" 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="radio-group" required="true" label="How did you hear about my services?&amp;nbsp;" name="how-did-you-hear-about-my-services-" other="true">&#13;
			<option label="Social Media" value="social-media">Social Media</option>&#13;
			<option label="Web search" value="web-search">Web search</option>&#13;
			<option label="Referral " value="referral-">Referral </option>&#13;
		</field>&#13;
		<field type="text" label="If by referral, who can I thank?&amp;nbsp;" name="if-by-referral-who-can-i-thank-" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Address"/>&#13;
		<field type="text" required="true" label="Address" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip Code" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Preferred Contact Method" name="preferred-contact-method">&#13;
			<option label="Email" value="email">Email</option>&#13;
			<option label="Text" value="text">Text</option>&#13;
			<option label="Phone" value="phone">Phone</option>&#13;
			<option label="Any" value="any">Any</option>&#13;
		</field>&#13;
		<field type="radio-group" label="Are you a Military Family?&amp;nbsp;" name="are-you-a-military-family-">&#13;
			<option label="Active Duty" value="active-duty">Active Duty</option>&#13;
			<option label="Retired " value="retired-">Retired </option>&#13;
			<option label="No " value="no-">No </option>&#13;
		</field>&#13;
		<field type="header" subtype="h1" label="Trip Details&amp;nbsp;"/>&#13;
		<field type="radio-group" required="true" label="What type of trip are you looking for?&amp;nbsp;" name="radio-group-1746033533612" other="true">&#13;
			<option label="Cruise" value="cruise">Cruise</option>&#13;
			<option label="All-Inclusive Resort" value="allinclusive-resort">All-Inclusive Resort</option>&#13;
			<option label="Disney destination " value="disney-destination-">Disney destination </option>&#13;
			<option label="Universal Studios " value="universal-studios-">Universal Studios </option>&#13;
			<option label="Hawaii " value="hawaii-">Hawaii </option>&#13;
			<option label="Europe" value="europe">Europe</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="How far into the planning process are you?&amp;nbsp;" name="how-far-into-the-planning-process-are-you-" other="true">&#13;
			<option label="Ready to book and deposit now" value="ready-to-book-and-deposit-now">Ready to book and deposit now</option>&#13;
			<option label="Ready to book and deposit but need to narrow down options first " value="ready-to-book-and-deposit-but-need-to-narrow-down-options-first-">Ready to book and deposit but need to narrow down options first </option>&#13;
			<option label="Wanting to plan a vacation but in the initial research phase" value="wanting-to-plan-a-vacation-but-in-the-initial-research-phase">Wanting to plan a vacation but in the initial research phase</option>&#13;
			<option label="I am just dreaming at this point, but may book in the future " value="i-am-just-dreaming-at-this-point-but-may-book-in-the-future-">I am just dreaming at this point, but may book in the future </option>&#13;
		</field>&#13;
		<field type="radio-group" label="How soon will you be able to place a deposit on the booking?&amp;nbsp;" name="how-soon-will-you-be-able-to-place-a-deposit-on-the-booking-" other="true">&#13;
			<option label="Today" value="today">Today</option>&#13;
			<option label="This week" value="this-week">This week</option>&#13;
			<option label="This  month" value="this-month">This  month</option>&#13;
			<option label="In a few months" value="in-a-few-months">In a few months</option>&#13;
		</field>&#13;
		<field type="date" required="true" label="Beginning date of travel?" name="beginning-date-of-travel" className="form-control"/>&#13;
		<field type="date" required="true" label="End date of travel?" name="end-date-of-travel" className="form-control"/>&#13;
		<field type="text" required="true" label="Number of Nights?&amp;nbsp;" name="number-of-nights-" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Are your dates flexible? If so, please provide details below&amp;nbsp;" name="are-your-dates-flexible-if-so-please-provide-details-below-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="What is your estimated budget?&amp;nbsp;" name="what-is-your-estimated-budget-" other="true">&#13;
			<option label="$2,500-$4,000" value="25004000">$2,500-$4,000</option>&#13;
			<option label="$4,001-$6,000" value="40016000">$4,001-$6,000</option>&#13;
			<option label="$6,001-$8,500" value="60018500">$6,001-$8,500</option>&#13;
			<option label="$8,501-$10,000+" value="850110000">$8,501-$10,000+</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Is that total per person or total of trip?&amp;nbsp;" name="is-that-total-per-person-or-total-of-trip-" other="true">&#13;
			<option label="Per person" value="per-person">Per person</option>&#13;
			<option label="Trip total " value="trip-total-">Trip total </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What does this Budget include?&amp;nbsp;" name="what-does-this-budget-include-" other="true">&#13;
			<option label="Everything (airfare, tickets, resort etc)" value="everything-airfare-tickets-resort-etc">Everything (airfare, tickets, resort etc)</option>&#13;
			<option label="Just Resort/Tickets etc. (no airfare) " value="just-resorttickets-etc-no-airfare-">Just Resort/Tickets etc. (no airfare) </option>&#13;
			<option label="I am not sure yet " value="i-am-not-sure-yet-">I am not sure yet </option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="Do you want Insurance included in your quote?&amp;nbsp;" name="do-you-want-insurance-included-in-your-quote-">&#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="Traveler Information&amp;nbsp;"/>&#13;
		<field type="text" required="true" label="Traveler 1: Full Name&amp;nbsp;" name="traveler-1-full-name-" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="DOB&amp;nbsp;" name="dob-" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Gender&amp;nbsp;" name="gender-">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female " value="female-">Female </option>&#13;
		</field>&#13;
		<field type="text" label="Traveler 2: Full Name&amp;nbsp;" name="traveler-2-full-name-" subtype="text" className="form-control"/>&#13;
		<field type="date" label="DOB&amp;nbsp;" name="date-1746035782697" className="form-control"/>&#13;
		<field type="radio-group" label="Gender&amp;nbsp;" name="radio-group-1746035786126">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female " value="female-">Female </option>&#13;
		</field>&#13;
		<field type="text" label="Traveler 3: Full Name&amp;nbsp;" name="traveler-3-full-name-" subtype="text" className="form-control"/>&#13;
		<field type="date" label="DOB&amp;nbsp;" name="date-1746035782320" className="form-control"/>&#13;
		<field type="radio-group" label="Gender&amp;nbsp;" name="radio-group-1746035786488">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female " value="female-">Female </option>&#13;
		</field>&#13;
		<field type="text" label="Traveler 4: Full Name&amp;nbsp;" name="traveler-4-full-name-" subtype="text" className="form-control"/>&#13;
		<field type="date" label="DOB&amp;nbsp;" name="date-1746035781952" className="form-control"/>&#13;
		<field type="radio-group" label="Gender&amp;nbsp;" name="radio-group-1746035786849">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female " value="female-">Female </option>&#13;
		</field>&#13;
		<field type="text" label="Traveler 5: Full Name&amp;nbsp;" name="traveler-5-full-name-" subtype="text" className="form-control"/>&#13;
		<field type="date" label="DOB&amp;nbsp;" name="date-1746035781560" className="form-control"/>&#13;
		<field type="radio-group" label="Gender&amp;nbsp;" name="radio-group-1746035785637">&#13;
			<option label="Male" value="male">Male</option>&#13;
			<option label="Female " value="female-">Female </option>&#13;
		</field>&#13;
		<field type="textarea" label="If you have more than 5 in your party, please add additional traveler information here including Full Name, DOB and gender.&amp;nbsp;" name="if-you-have-more-than-5-in-your-party-please-add-additional-traveler-information-here-including-full-name-dob-and-gender-" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="Additional Information&amp;nbsp;"/>&#13;
		<field type="textarea" label="Is there anything additional you would like me to know?&amp;nbsp;" name="is-there-anything-additional-you-would-like-me-to-know-" className="form-control"/>&#13;
		<field type="textarea" label="Are you celebrating anything special on this trip (birthday, anniversary, etc.)?" name="are-you-celebrating-anything-special-on-this-trip-birthday-anniversary-etc" className="form-control"/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>