I cannot enter any data in my form fields

My form was created on my Facebook fan page correctly, but I cannot enter any data in the fields! For some reason, I cannot enter any data in the preview section on jotform's website either.

https://www.facebook.com/EliSimone?sk=app_190322544333196&app_data=visitor_mode

This is a re-post of a comment on Adding a Contact Form to Your Facebook Page