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