Share your information with Courtney Jackson

Courtney Jackson

Wishful Escapes, LLC

<html>
  <body>
    <form-template>&#13;
	<fields>&#13;
		<field type="header" subtype="h2" label="Please complete the form below to receive a Disney Cruise quote."/>&#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 required="true"  type="text" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Cruise Information"/>&#13;
		<field type="select" label="Have you sailed on Disney Cruise Line before?" name="have-you-sailed-on-disney-cruise-line-before" className="form-control">&#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 staterooms will you need?" name="how-many-staterooms-will-you-need" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many adults will be traveling?" name="how-many-adults-will-be-traveling" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="How many children will be traveling?" name="how-many-children-will-be-traveling" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Please list the ages of the children (at time of travel)" description="This information is very information in providing accurate cruise quotes." name="please-list-the-ages-of-the-children-at-time-of-travel" subtype="text" className="form-control"/>&#13;
		<field type="paragraph" subtype="p" label="If you need more than one stateroom, please enter the information in the following format:"/>&#13;
		<field type="paragraph" subtype="p" label="For example:"/>&#13;
		<field type="paragraph" subtype="p" label="Stateroom #1: 2 adults, 2 children (ages 5 and 10)"/>&#13;
		<field type="paragraph" subtype="p" label="Stateroom #2: 1 adult, 3 children (ages 2, 4, and 6)"/>&#13;
		<field type="textarea" label="Enter Here:" name="enter-here" className="form-control"/>&#13;
		<field type="text" label="If you require airfare, what is your preferred departure airport (s)?" name="if-you-require-airfare-what-is-your-preferred-departure-airport-s" subtype="text" className="form-control"/>&#13;
		<field type="text" label="What is your preferred airline?" name="what-is-your-preferred-airline" subtype="text" className="form-control"/>&#13;
		<field type="textarea" label="Do you have any Special Request/Accommodations Special Needs? Please describe below&amp;nbsp;" name="do-you-have-any-special-requestaccommodations-special-needs-please-describe-below-" className="form-control"/>&#13;
		<field type="header" subtype="h3" label="Thank you! Please allow 48-72 hours for your cruise quote."/>&#13;
	</fields>&#13;
</form-template>
  </body>
</html>