subject_line
Date
*
+
In Game Name
*
RANK
*
Iron
Bronze
Silver
Gold
Platinum
Diamond
RANK #
*
1
2
3
4
Role
*
Jungle
Mid
Top
ADC
Support
Fill
Secondary Role
*
Jungle
Mid
Top
ADC
Support
Fill
Discord
*
🛈
Twitch Name
*
U.GG VERIFICATION LINK
*
Email Address for refunds
*
🛈
Donation Amount
*
SUB FREEPLAY($0.00)
I wanna play ($5.00)
Here is a ten ya dumb bishhh! ($10.00)
Feed a boomer ($15.00)
To fix your hairline ($20.00)
I want to breach those GATEZ ($25.00)
Get Cucked ($30.00)
LATA Bitches!! ($100.00)