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[b]Your Name/Master Account Name:[/b] --Text--
[b]Date of Ban:[/b] --Text--
[b]Reason Given:[/b] --Text--
[b]Explanation/Defense:[/b] --Text--
[b]Evidence (Screenshots/Logs):[/b] --Text--
[b]Promise / Plan to Avoid Future Violations::[/b] --Text--