Unable to add Form entry location to report header

[thatlem]

I have a form which have address fields that I need to link into the header of reports.
The form is a popup that allows for facility address information. This is a one-time entry and is linked back to tbl_default_location. I then entered a series of unbound text fields that I linked back to the table. However when I run the report, all I get are errors.

Suggestions.