Certainly! Here's an example of how you can convert the battery issue questionnaire into a form format for a Shopify page: ```

Customer Name Vendor Original Purchase Date Battery Model Description of the Present Issue/Behavior Date the Battery Last Functioned as Expected Is there Physical Damage that can be observed by eye? Yes No Images/Video of the Battery Pack (removed from bag) from all angles Images/Video of Connectors and Charger Submit

``` You can customize and style this form as per your Shopify store's design. Make sure to adjust the form's action attribute to the appropriate endpoint for handling form submissions.