Some people might not like the referrer name in the middle for some reason.
How can you remove that?
Well, if you want your form to be clean from any referrer or sponsor. Then first try to go to the main site without clicking on the referral link. You can do this by clearing the ref=whatever bit out https://www.mypayingads.com/index.php or just copy the actual web address and paste in the address bar www.mypayingads.com and hit enter.
Remember this (top tip) works only if you didn't click on the referral link. Once you click on it then the browser will remembers the referrer or sponsor. So in that case (you've already clicked on it) you will have to clear your cookies.
Once you have cleared your cookies, reload the page. After reloading the page you will see the form is clear like this.
How to clear cookies from browsers?
Firefox: click on the 3 lines at the top right hand corner >> Options >> Privacy >> Remove individual cookies. or just cope what ever in the brackets (about:preferences#privacy) and past in the address bar then hit enter.