Explain why you think this got blacklisted, if known.
Explain why you think it should no longer be listed.
Provide your contact information, to give your request more credibility.
Provide the text of the Non-Delivery Report, if known? Or, if you don’t have an NDR, how did you discover that this was listed?
Your 'from' e-mail address should be using either a legitimate ISP or your organization’s domain name. Therefore, avoid sending requests from a freemail address (yahoo, gmail, hotmail, etc), if possible.
We reserve the right to ignore requests which are BOTH (a) sent from freemail services (or hidden reg domains) AND (b) which have zero legitimate contact information. [A+B = an anonymous request!] Other requests which otherwise egregiously ignore the instructions listed above may be treated likewise!
NOTE: This last point is primarily aimed at certain snowshoe spammers and certain blackhat ESPs who constantly spam the removal request form, try to be as anonymous as possible... and yet spam is continually sent from the very IPs and domains they submitted for a delisting.