Warranty Claim Form

This form is used by customers to submit a warranty claim for a defective or malfunctioning product. Please fill in all required fields accurately to initiate the claim process.

Customer Information

Full Name: {fullName}

Email Address: {email}

Phone Number: {phoneNumber}

Address: {address}

Product Information

Product Name: {productName}

Model Number: {modelNumber}

Serial Number: {serialNumber}

Purchase Date: {purchaseDate}

Retailer: {retailer}

Issue Description

Problem Description:

{problemDescription}

Photos of Product (If Applicable)

{#photos}

{photoDescription}

{%photo}

{/photos}

{^photos}No photos were uploaded with this claim.{/photos}

Actions Taken

{#actionsTaken}

• {action}

{/actionsTaken}

Previous Support Contact

{#hasContactedSupport}Customer has previously contacted support regarding this issue.
Support Ticket ID: {supportTicketId}
Support Response Summary:
{supportResponse} {/hasContactedSupport}

{^hasContactedSupport}Customer has not contacted support previously.{/hasContactedSupport}

Replacement or Refund Preference

Customer Preference: {preference}

Additional Notes

{additionalNotes}

Submitted Products

Declaration

I, {fullName}, confirm that all provided information is accurate to the best of my knowledge and understand that providing false claims may result in denial of warranty processing.

Signature: {signature}

Date: {submissionDate}