Hi Michael,
Your page refers to a few files that it needs to function properly.
Your current code shows these:
<link href="../../../SpryAssets/SpryValidationTextField.css" rel="stylesheet" type="text/css" />
<script src="../../../SpryAssets/SpryValidationTextField.js" type="text/javascript"></script>
<link href="../../../SpryAssets/SpryValidationTextarea.css" rel="stylesheet" type="text/css" />
<script src="../../../SpryAssets/SpryValidationTextarea.js" type="text/javascript"></script>
<link href="../../../CSSFormBuilder/FD_Sharp_Default.css" rel="stylesheet" type="text/css" />
The ../../../ part of these is telling the page to look for the files in a folder that is below even your root folder - so is not correct.
Upload the folders 'SpryAssets' and 'CSSFormBuilder' to their default places on your remote site (the directories should be in the root folder) and change the links in your page to point to these files relative to your page.
If you have problems with the links, post back details of where the uploaded files have been put (in which directory - and sub-directories etc.)