Hello, and thanks for asking for this info!
- The originating server which you want to transfer a character from: Vrook Lamar
- The name of a character on that server: Saruni
- Your specific issues with the form - no characters shown and buttons are all disabled.
If you want to see what the page has output, here is a gist:
https://gist.github.com/2412041
REDACTED denotes things that may or may not have been personally identifying.