Subscription form shows as brackets and it needs to auto fill

Any help on the would be great...

The subscription for is showing up to some recipients as brackets not fillable form fields.

I also... I need the form to auto fill so what do I put in the VALUE?

AND is the line of code I put in the action correct?

http://monkeywrenchmarketing.createsend.com/t/y/s/toss?cm-hyijkh-hyijkh=[email]&cm-name=[fullname, fallback=""]
Thanks in advance to any much needed help.

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