This legal template includes 9 fields. Capture initial details of a product liability claim from a consumer or business. Free to customize and use on ZenBuild.
Claimant Full Name (text, required)
Email Address (email, required)
Product Name and Model (text, required)
Date of Incident (text, required)
Description of Injury or Damage (long text, required)
Was the product used as intended? (multiple choice, required) — options: Yes, No
Where was the product purchased? (text, required)
Photos of Product and Injury/Damage (file upload, optional)
Medical or Repair Costs Incurred (long text, optional)
