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I did check your wix page and it seems the form fields are being displayed correctly. Please check the screenshot below:
With which browser you are having this issue with? I would suggest you to clear your browser cache and see if that solves your problem. The following guide should help you clearing browser cache: http://www.wikihow.com/Clear-Your-Browser's-Cache
If the issue persists, do get back to us with a screenshot of the problem. The following guide should help you upload image in forum post: https://www.jotform.com/answers/277033