[b][i][u]Name:[/u][/i][/b]
[b][i][u]Steam64ID:[/u][/i][/b]
[b][i][u]Date of Incident:[/u][/i][/b]
[b][i][u]Time of Incident:[/u][/i][/b]
[b][i][u]Amount your claiming:[/u][/i][/b]
[b][i][u]Description of situation:[/u][/i][/b]
[b][i][u]Evidence:[/u][/i][/b]
Name:
Steam64ID:
Date of Incident:
Time of Incident:
Amount your claiming:
Description of situation:
Evidence:
