Solved
SanfordWhitemanAccepted solution
Level 10
February 8, 2017
You have Progressive Profiling turned on on this page. Thus you are defining the form fields as being shown only until they are non-empty: that's what ProgPro is.
Please try to provide more verbose information in posts. Screenshots are not suitable for troubleshooting JavaScript and HTML issues. It was only because you leaked the URL in the screenshot that I was able to look at this.