Contact info from website not importing into Zoho

Contact info from website not importing into Zoho

Hey,
I added the zoho HTML into my "contact us" page at mountainridgecapital.com but when I enter my own information in there, I do not show up as a new lead in zoho.
 
I did edit a couple of the fields in the HTML ( I changed "Industry New" to just read "Industry" I also changed the title bar from "Web Form" to "Contact US"
 
What can I do to collect my contacts data?
Thanks,
-Steven