Custome Web Form Needed

Hello Freelancers. We have a special problem we want fixed with our webform. I want to be able to capture a IP address, and Location from the webform and have it submit the information to a hidden field that is a custom tag for my email and marketing management system. Let me outline it. Name Email Phone number And I also want a hidden field that captures location, IP and submits it to a hidden custom field. Here is the CODE minus my API key - I will work with you to get this done: Here are the two custom fields I can add into the code for the hidden values. Make it hidden, get the location in 2_20 and the browser if you can in 5_20/ <input type="text" name="CustomFields[2]" id="CustomFields_2_20" value="" size='50'></td> <input type="text" name="CustomFields[5]" id="CustomFields_5_20" value="" size='50'></td> This is a PHP sidebar that is called to each of my webpages: