Th ethree radio buttons are supposed to have the same name; Priority.
It seems that the have different names. Double click them, and set the Group name for all three to be the same: Priority
Captcha image: in the captcha image code, there are TWO positions where you need to place your own domain name URL http;//www.....
You have probably placed in only in one of the two, OR you have mistyped the second. Check it.
Is there somewhere I can go to just tell someone what I want on the form and they create it for me and just give me the code to enter on my page? I have tried continuously several different forms and none of them will work. I need a form that is embedded in the page, not one that opens up your email to send it.