Here is sample how your request should be posted:
1: NickName?
sanduduk
2: Who banned you?
autoban
3: Why did you got banned?
leaving
4: Reason that forced you to break the rule?
i left the game becouse bug, I could not pick hero, i tryed and tryed and tryed, but no success, and i decide to leave before the 5th min, i didnt want to ruin the game
5: Explain to us a general vision about the situation!
<If there was anything or anyone worth to mention in your unban request - write it here>
6: Link of the game?
http://dota.eurobattle.net/la/forum/index.php?action=gameinfo;sa=game;gid=5705065