Amount 1
Categories
Please Select
Option 1
Option 2
Option 3
Option 4
Amount 2
Categories
Please Select
Option 1
Option 2
Option 3
Option 4
Amount 3
Categories
Please Select
Option 1
Option 2
Option 3
Option 4
Amount 4
Categories
Please Select
Option 1
Option 2
Option 3
Option 4
Total Amount
Total Option 1
Category1#1
Category1#2
Category1#3
Total Option 2
Category2#1
Category2#2
Category2#3
Total Option 3
Category3#1
Category3#2
Category3#3
Total Option 4
Submit
Should be Empty: