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There are 5 questions: name, email, and 3 about what you need help with.  Should take you about 2-10 minutes to fill out, depending on what you'd like to say.
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Name *

(or whatever you'd like to be addressed as)
 
What you need help with

(give us an idea of what it is you need help with. Tell us about what you're trying to achieve, a bit about your reasoning behind it, and perhaps anything that's going wrong)
 
Tell us a bit about you

(it helps if we know a bit of background so we can understand the context of the issue better. Tell us about your role as it relates to the previous answer and to the organisation. E.g. "I am the IT lead" or "I'm responsible for all email marketing", etc.)
 
Anything else

(that you think we should know)
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