This code is called a captcha code and it is used to verify that the form is being filled out by a person rather than any kind of spamming software. The spamming software cannot pick up the distorted letters and numbers in the code code where as the human eye can.
Simply enter the numbers and letters as you see them in the image on the box underneath. The form will only successfully submit if you enter the code correctly.
Should you not be able to read the code simply click the reload image button and a new code will be displayed.