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Data Collection

Date:
{date-1}

First Name:
{name-2-first-name}

Last Name:
{name-2-last-name}

Business Address (City, State, Zip)
{address-1-street_address}

City:
{address-1-city}

State:
{address-3-state}

Zip Code:
{address-1-zip}

Company Name:
{text-1}

Email:
{email-1}

Mobile Phone Number:
{phone-3}

Crop Type:
{text-11}

Section 1

Country	State	Crop	Contracted Acres
{address-2-country}	{address-2-state}	{select-7}	{text-11}

Section 2

Country	State	Crop	Contracted Acres
{address-3-country}	{address-3-state}	{select-10}	{text-13}

Section 3

Country	State	Crop	Contracted Acres
{address-4-country}	{address-4-state}	{select-13}	{text-14}

Section 4

Country	State	Crop	Contracted Acres
{address-5-country}	{address-5-state}	{select-14}	{text-15}

Section 5

Country	State	Crop	Contracted Acres
{address-6-country}	{address-6-state}	{select-19}	{text-16}

Section 6

Country	State	Crop	Contracted Acres
{address-7-country}	{address-7-state}	{select-22}	{text-17}

Section 7

Country	State	Crop	Contracted Acres
{address-8-country}	{address-8-state}	{select-25}	{text-18}