{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_1\"><h4>Date <\/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_3\"><h4>Phone number <\/h4><input type=\"text\" name=\"custom_field[3]\" value=\"\" id=\"custom_field_3\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_5\"><h4>Station Name<span class='required'> *<\/span> <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-0]\" value=\"Apia\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Apia<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-1]\" value=\"Faleata\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Faleata<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-2]\" value=\"Salelaloga\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Salelaloga<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[5-3]\" value=\"Asau\" id=\"custom_field_5\" \/><label for=\"custom_field[5]\" > Asau<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[5-BLANKHACK]\" value=\"\"  \/>\n<\/div><div class=\"report_row\" id=\"custom_field_row_7\"><h4>Crew <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[7-0]\" value=\"Alpha\" id=\"custom_field_7\" \/><label for=\"custom_field[7]\" > Alpha<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[7-1]\" value=\"Bravo\" id=\"custom_field_7\" \/><label for=\"custom_field[7]\" > Bravo<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[7-2]\" value=\"Charlie\" id=\"custom_field_7\" \/><label for=\"custom_field[7]\" > Charlie<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[7-3]\" value=\"Delta\" id=\"custom_field_7\" \/><label for=\"custom_field[7]\" > Delta<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[7-4]\" value=\"VERT\" id=\"custom_field_7\" \/><label for=\"custom_field[7]\" > VERT<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[7-BLANKHACK]\" value=\"\"  \/>\n<\/div><div class=\"report_row\" id=\"custom_field_row_6\"><h4>Station Name <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[6-0]\" value=\"Faleata\" id=\"custom_field_6\" \/><label for=\"custom_field[6]\" > Faleata<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[6-BLANKHACK]\" value=\"\"  \/>\n<\/div><div class=\"report_row\" id=\"custom_field_row_8\"><h4>Vehicles Used <\/h4><table border=\"0\"><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-0]\" value=\"A1R\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > A1R<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-1]\" value=\"F1R\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F1R<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-2]\" value=\"F1\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F1<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-3]\" value=\"F11\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F11<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-4]\" value=\"F12\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F12<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-5]\" value=\"F2R\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F2R<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-6]\" value=\"F22\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > F22<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-7]\" value=\"Amby1\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > Amby1<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-8]\" value=\"T1\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > T1<\/label><\/span><\/td><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-9]\" value=\"Fire1\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > Fire1<\/label><\/span><\/td><\/tr><tr><td><span class=\"custom-field-option\"><input type=\"checkbox\" name=\"custom_field[8-10]\" value=\"Hazard1\" id=\"custom_field_8\" \/><label for=\"custom_field[8]\" > Hazard1<\/label><\/span><\/td><\/tr><\/table><input type=\"hidden\" name=\"custom_field[8-BLANKHACK]\" value=\"\"  \/>\n<\/div><\/div>"}