Formulir Claim Garansi

Judul pada opt-in popupasdadf

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[text* your-name id:name placeholder "Nama Lengkap"]

[email* your-email id:email placeholder "Email"]

[tel* your-phone id:phone placeholder "Nomor Telepon"]

[text* product-name id:product-name placeholder "Nama Produk"]

[date* purchase-date id:purchase-date placeholder "Tanggal Pembelian"]

[text* serial-number id:serial-number placeholder "Nomor Seri Produk"]

[textarea* problem-description id:problem-description placeholder "Deskripsi Masalah"]

[file* additional-files id:additional-files]

[submit "Kirim Klaim"]