{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_1\"><h4>Will this issue effect they way you vote? <\/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>Will you contact your local officials and make your concerns known? <\/h4><input type=\"text\" name=\"custom_field[2]\" value=\"\" id=\"custom_field_2\" class=\"text custom_text\" \/><\/div><\/div>"}