Share your information with Katherine Jordan

Katherine Jordan

Peacock Travel Group

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		<field type="header" subtype="h1" label="CLIENT INFORMATION"/>&#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" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" 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="Preferred Communication Style (email, call, text, etc.)" name="preferred-communication-style-email-call-text-etc" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="MAILING ADDRESS"/>&#13;
		<field type="text" required="true" label="Street 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" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="header" subtype="h1" label="ABOUT YOUR TRIP"/>&#13;
		<field type="text" required="true" label="Where would you like to go?" name="where-would-you-like-to-go" subtype="text" className="form-control"/>&#13;
		<field type="date" label="When would you like to depart?" name="when-would-you-like-to-depart" className="form-control"/>&#13;
		<field type="date" label="When would you like to return?" name="when-would-you-like-to-return" className="form-control"/>&#13;
		<field type="radio-group" label="Are your dates flexible?" name="are-your-dates-flexible">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="text" label="What&amp;nbsp; is your departure city/preferred starting airport?" name="what-is-your-departure-city" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Is this vacation to celebrate anything special?" name="is-this-vacation-to-celebrate-anything-special" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="At what phase of planning are you in?" name="at-what-phase-of-planning-are-you-in">&#13;
			<option label="Just getting started with no details defined" value="just-getting-started-with-no-details-defined">Just getting started with no details defined</option>&#13;
			<option label="We have dates, but we need everything else." value="we-have-dates-but-we-need-everything-else">We have dates, but we need everything else.</option>&#13;
			<option label="Flights are all booked...now help us fill in the blanks." value="flights-are-all-bookednow-help-us-fill-in-the-blanks">Flights are all booked...now help us fill in the blanks.</option>&#13;
		</field>&#13;
		<field type="radio-group" required="true" label="What is your budget for all travelers? This just gives me a general starting point and can always be changed later." name="what-is-your-budget-for-all-travelers-this-just-gives-me-a-general-starting-point-and-can-always-be-changed-later">&#13;
			<option label="$2,000 - $5,000" value="2000-5000">$2,000 - $5,000</option>&#13;
			<option label="$5,000 - $7,000" value="5000-7000">$5,000 - $7,000</option>&#13;
			<option label="$7,000 - $10,000" value="7000-10000">$7,000 - $10,000</option>&#13;
			<option label="$10,000 - $15,000" value="10000-15000">$10,000 - $15,000</option>&#13;
			<option label="$15,000+" value="15000">$15,000+</option>&#13;
		</field>&#13;
		<field type="checkbox-group" label="What travel components would you like us to assist you with? Check all that apply." name="what-travel-components-would-you-like-us-to-assist-you-with-check-all-that-apply">&#13;
			<option label="Flights" value="flights">Flights</option>&#13;
			<option label="Accommodations" value="accommodations">Accommodations</option>&#13;
			<option label="Transportation (car rental, trains, etc.)" value="transportation-car-rental-trains-etc">Transportation (car rental, trains, etc.)</option>&#13;
			<option label="Excursions &amp; tours" value="excursions-tours">Excursions &amp; tours</option>&#13;
			<option label="Insurance" value="insurance">Insurance</option>&#13;
			<option label="Other" value="other">Other</option>&#13;
		</field>&#13;
		<field type="radio-group" label="What best describes your desired accommodation style?" name="what-best-describes-your-desired-accommodation-style">&#13;
			<option label="Romance" value="romance">Romance</option>&#13;
			<option label="Rest &amp; relaxation" value="rest-relaxation">Rest &amp; relaxation</option>&#13;
			<option label="Off the beaten path" value="off-the-beaten-path">Off the beaten path</option>&#13;
			<option label="Party" value="party">Party</option>&#13;
			<option label="Local culture" value="local-culture">Local culture</option>&#13;
			<option label="Family friendly" value="family-friendly">Family friendly</option>&#13;
			<option label="Food &amp; wine" value="food-wine">Food &amp; wine</option>&#13;
			<option label="Adventure" value="adventure">Adventure</option>&#13;
		</field>&#13;
		<field type="textarea" label="Is there anything else you &quot;must do&quot; or see?" name="is-there-anything-else-you-must-do-or-see" className="form-control"/>&#13;
		<field type="textarea" label="Describe your vision for your ideal vacation." name="describe-your-vision-for-your-ideal-vacation" className="form-control"/>&#13;
		<field type="textarea" required="true" label="FULL names (including middle) and BIRTHDATES, exactly as listed on government ID for ALL travelers" placeholder="FULL LEGAL NAMES AND BIRTHDATES (as on passport for international travel or driver license for domestic travel)" name="who-all-will-be-traveling-with-you-please-list-all-full-names-including-middle-and-birthdates-as-listed-on-passport" className="form-control"/>&#13;
		<field type="text" label="How did you hear about us?" name="how-did-you-hear-about-us" subtype="text" className="form-control"/>&#13;
		<field type="select" required="true" label="Would you like to be subscribed to our newsletter and travel updates?" name="would-you-like-to-be-subscribed-to-our-newsletter-and-travel-updates" className="form-control">&#13;
			<option label="Yes" value="yes">Yes</option>&#13;
			<option label="No" value="no">No</option>&#13;
		</field>&#13;
		<field type="paragraph" subtype="p" label="By submitting this client inquiry form, you consent to receive travel related content via email from Peacock Travel Group."/>&#13;
	</fields>&#13;
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