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Notice to Privacy Control tools users (such as Norton Internet Security). You would be wise to protect the personal information such as banking details, credit card numbers and other confidential information that you provide online. To do so with "Norton Privacy Control," simply enter the information that you wish to secure, and the "Confidentiality" section will ensure that someone does not send it by accident to an unprotected site. It will also prevent websites from registering your e-mail address without you knowing it, and placing cookies to analyze your surfing behavior." "Norton Privacy Control" now enables you to block the secret transmission of your confidential information. In a way this form is doing some research on the visitor in the script body. The hidden fields are being passed to the script and are being collected from the form.
in order to complete the form successfully check for the availability of such product as Norton and if so simply disable the privacy control or confidentiality control.