{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_6\"><h4>What is it?<span class='required'> *<\/span> <\/h4><input type=\"text\" name=\"custom_field[6]\" value=\"\" id=\"custom_field_6\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_1\"><h4>Price of Food Item<span class='required'> *<\/span> <\/h4><input type=\"text\" name=\"custom_field[1]\" value=\"\" id=\"custom_field_1\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_2\"><h4>Currency Type<span class='required'> *<\/span> <\/h4><select name=\"custom_field[2]\" id=\"custom_field_2\">\n<option value=\"US Dollars\">US Dollars<\/option>\n<option value=\"Canadian Dollars\">Canadian Dollars<\/option>\n<option value=\"Mexican Pesos\">Mexican Pesos<\/option>\n<option value=\"Euros\">Euros<\/option>\n<option value=\"British Pound\">British Pound<\/option>\n<option value=\"Russian Rubles\">Russian Rubles<\/option>\n<option value=\"Australian Dollar\">Australian Dollar<\/option>\n<option value=\"New Zealand Dollar\">New Zealand Dollar<\/option>\n<option value=\"Chinese Yuan\">Chinese Yuan<\/option>\n<option value=\"Indian Rupee\">Indian Rupee<\/option>\n<option value=\"Hong Kong Dollar\">Hong Kong Dollar<\/option>\n<option value=\"Indonesian Rupiah\">Indonesian Rupiah<\/option>\n<option value=\"Other\">Other<\/option>\n<\/select><\/div><div class=\"report_row\" id=\"custom_field_row_4\"><h4>Place of Purchase<span class='required'> *<\/span> <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Neighborhood Food Market <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Neighborhood Food Market\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Supermarket <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Supermarket\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Superstore like COSTCO <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Superstore like COSTCO\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Mail-order <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Mail-order\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Online Store <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Online Store\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Street Vendor <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Street Vendor\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Food Cart\/Truck <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Food Cart\/Truck\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Farmers Market <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Farmers Market\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > The Farm <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"The Farm\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > My Back Yard <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"My Back Yard\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Other <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Other\" id=\"custom_field_4\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_3\"><h4>Food Quality<span class='required'> *<\/span> <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Great <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Great\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Good <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Good\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Okay <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Okay\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Poor <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Poor\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Inedible <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Inedible\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > I don't know <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"I don&#039;t know\" id=\"custom_field_3\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_5\"><h4>How far did your food travel?<span class='required'> *<\/span> <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Locally Produced Food <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Locally Produced Food\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Food Grown in My State <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Food Grown in My State\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Food Produced in my Country <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Food Produced in my Country\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Food Travelled Over 3000 miles <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Food Travelled Over 3000 miles\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Food Grown on Another Continent <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Food Grown on Another Continent\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Food Produced Half-way Around the World <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Food Produced Half-way Around the World\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Unknown <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Unknown\" id=\"custom_field_5\" \/><\/span><\/div><\/div>"}