I'm so close to having it figured out but still something is off.
I made the modifications. Form loads correctly.
But When I fill out all the fields, the page reloads and three fields are empty. Each have the red text requesting that I fill out the info.
The fields are the Business Name, Phone, and Fax.
I tried a couple different modifications but nothing seems to be working.
Can you take a look at the code and screen shot attached.