[{"type":"text","subtype":"text","required":true,"name":"company-name","label":"Company Name:","className":"form-control"},{"type":"text","subtype":"text","required":true,"name":"Contact Name:","label":"Contact Name:","className":"form-control"},{"type":"text","subtype":"text","required":true,"name":"phone","label":"Phone:","className":"form-control"},{"type":"text","subtype":"text","required":true,"name":"email","label":"Email:","className":"form-control"},{"values":[{"value":"Yes","label":"Yes"},{"value":"No","label":"No"}],"type":"checkbox-group","required":true,"name":"do-you-have-a-relationship-with-acosta","label":"Do you have a relationship with Acosta?","className":"checkbox-group"},{"type":"text","subtype":"text","name":"text-1507228840101","label":"If yes where?","className":"form-control"},{"type":"textarea","name":"in-what-walmart-departments-do-you-currently-have-distribution","label":"In what Walmart departments do you currently have distribution?","className":"form-control"},{"type":"textarea","name":"what-key-information-would-you-like-to-know-about-acosta-andor-the-walmart-psp-","label":"What key information would you like to know about Acosta and/or the Walmart PSP?","className":"form-control"},{"type":"textarea","name":"Please provide any additional information you feel would be beneficial.","label":"Please provide any additional information you feel would be beneficial.","className":"form-control"}]
General - Walmart PSP Inquiry