[b]Account name:[/b]
[b]Serial:[/b]
[b]Last nick name:[/b]
[b]Story behind lost email:[/b]
[b]Account(s) I use [u]besides[/u] my main account:[/b]
[b]New Email that I'd like to use:[/b]
[b]I'm making this request from home (Y / N):[/b]
[b]I play in an internet cafe (Y / N):[/b]
[b]I have been part of the following in-game groups:[/b]
[b]I agree that the information given is correct and truthful:[/b]