[b]Name -[/b] What is your in-game name?
[b]STEAM-ID -[/b] What is your STEAM-ID? 
[b]Admins name -[/b] Who banned you/who might it be?
[b]Reason -[/b] What is/might be the reason that you got banned?
[b]Server -[/b] What server did you get banned from?
[b]Time -[/b] How long were you banned for?
[b]Story -[/b] What happend?
[b]Proof -[/b] Any proof on a video/screenshot that clearly show what happened?
[b]Extra information -[/b] Any thing you think may be relevant to your ban.

[b]Staff Member(s) Name:[/b]

[b]Staff Member(s) SteamID:[/b]

[b]What did the Staff Member(s) do?:[/b]

[b]What server(s) was this on?:[/b]

[b]Evidence:[/b]