Form build

[bluerivercarp]

Looking for assistant or a job opportunity with this form:

https://bluerivercarp.com/pages/product-tester-application

Using the built-in shopify forms.

I would like it where this form will populate the existing database to include Name, Address, City, State, zip, county code. email, phone.  Currently working is name, email, phone, and the custom fields.  So, I'm having to re-input the address information on every submission.