A systems request form should not have a blank space for the company name. The system will be able to tell what company it belongs to by looking at the email address submitted with the form. The company name and the email address should be on separate lines so that they can’t be edited to look like one.
Email addresses are often used for authentication purposes so it is secure to keep them out of sight from the public in this form. If a user types their email into the “Company” box then there will not even need to be an “email” input since all fields will have been filled out correctly by default when submitted with just those two pieces of information typed in at least once during registration (those being what identifies someone as currently registered).
The system request form should not allow any blank spaces or empty boxes where data would normally go because it could lead to errors.