Warranty claim form
A warranty claim form lets a customer report a product defect and request repair, replacement or refund within the warranty period. By collecting the order number, serial number, purchase date and a detailed description of the defect in one place, you have all the information you need to assess the claim fairly without back-and-forth emails. The form collects the request only — no refund, repair or replacement happens automatically through it.
The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.
Purchase date is a date field, not text
A structured date field makes it easy to calculate whether the product is still within the warranty period. Text requires manual decoding and is error-prone.
Preferred resolution is a dropdown, not free text
A dropdown with clear options sets customer expectations and makes it obvious what they are asking for, rather than inviting vague requests.
This one uses file uploads, which is a paid feature — you can build and edit it on the free plan, but saving it needs an upgrade.
No card required.
Warranty Claim
Live previewHow to build this form
7 steps in the editor.
- Add text fields for the customer's name and email address so you know who is making the claim.
- Add a text field for order number or serial number — the identifier you use to look up the original purchase.
- Add a date field for purchase date so you can verify the product is still within the warranty window.
- Add a text field for product name and an optional text field for model or SKU.
- Add a required textarea for defect description — let the customer describe exactly what is wrong in their own words.
- Add a dropdown for "preferred resolution" so customers signal intent and you can guide your decision.
- Optional: add a file upload field for a photo of the defect.
Fields in this form
9 fields, using 6 of the 19 field types available.
| Question | Field type | Required |
|---|---|---|
| Full name | Short text | Yes |
| Email address | Yes | |
| Order number or serial number | Short text | Yes |
| Purchase date | Date | Yes |
| Product name | Short text | Yes |
| Model or SKU (optional) | Short text | Optional |
| Defect description | Long text | Yes |
| Preferred resolution | Dropdown | Yes |
| Photo of defect (optional) | File upload | Optional |
What goes wrong with this form
Specific to a warranty claim form, not general advice about forms.
Not asking for purchase date or order number
Without proof of purchase, you cannot verify the product is within the warranty window. Always collect the order number, serial number, or purchase date.
Skipping the defect description textarea
A short text field makes it too easy for a customer to write "doesn't work" without detail. A textarea with a specific placeholder encourages detail.
Using a free-text field for resolution instead of a dropdown
Open text fields invite requests outside your warranty scope. A dropdown with your actual options sets clear boundaries.
Questions about this form
Does this form automatically approve claims?
No. This form collects the claim information only. You review each claim against your warranty policy and approve or deny it manually. No refund or replacement happens automatically through the form.
How do I know if a claim is within the warranty period?
The purchase date field shows you when the product was bought. Compare that to today's date and your warranty terms. If the product is within the window and the defect is covered, you approve it.
What if the customer doesn't have the order number?
Ask for the serial number instead, or the email they used at checkout. Most of the time you can look up the order from either.
This one uses file uploads, which is a paid feature — you can build and edit it on the free plan, but saving it needs an upgrade.