Issue with address field

I’m having an issue with the address field in my form on my website. Has anyone ever come across this problem and know how to fix the issue?

I’ve had a lot of spam send to this website so I have put a secure pass code in order to access the form, but if anyone needs to see an image of whats going on you can click the link above, it’s a screen shot of the issue.

If you can help me resolve the problem please let me know, i’d really like to get this form up as soon as I can so that my clients can use it.

Thanks!

The page I need help with: [log in to see the link]