Trouble with form

I have been trying to build a form for two days. Every time I try to edit the form, the preview page shows me things I did not do - and I cannot figure out how to delete them.  This is driving me crazy.

This is my form: http://form.jotform.us/form/52355062778158

This is really very straight-forward. I am thinking to pay more for another form building site and just give up on Jotform. 

I'm on deadline and I'm sick.

Please just call me so I can ask questions directly 310-472-3343

Thank you

Ann Colburn