Short code subscription form indicates my WP log in information.

Hi Jack,

Thanks for the reply. I guess my question should have been. I understand I need the short code. However, how do I eliminate showing my information, and will this affect my admin access as administrator. The form clearly states I can't change the username. I hope this makes sense. The information displayed clearly shows WP log in details. I do not want to show this information for obvious reasons.

It appears that I was automatically added as a user because of the General Settings.