Why my account has been auto-suspended?

I was trying to view my form after finishing some edits and was given an error saying the form not enabled (which it was). I then logged out in hopes it was just a little bug but when I went to log back in I was not able to. I was given the message that I was auto suspended. 

Could you please help? Thanks in advanced! 

P.S. My login is the same as my email (in case that matters :) )

I have checked your account and it has been suspended due to a high phishing score, it happened since you are asking for login credentials on your form http://www.jotform.us/form/71525466850157 

Here is a screenshot of the guilty fields: 

Do note that asking for this kind of information goes against our terms, please take a look on the following page so you know why you can be suspended: http://www.jotform.com/terms/ 

I have also removed the fields from your form in order to reactivate your account. 

If you have any question, let us know.