Shopify Return/Warranty Form Build

I run two separate Shopify stores and need a single-page return / warranty form built for each of them. Customers must be able to: • Complete all relevant details online – First Name, Last Name, Company Name, Phone, Email, Order Number, Date of Purchase, Product Code, Quantity, Mechanics Name, Mechanics Licence Number, Vehicle VIN and a free-text Description of Issue. • Choose a reason from a drop-down that includes: Incorrect item received; Warranty; Item not working; Dead on arrival; Change of mind (20 % restocking fee + postage costs); Ordered by mistake (20 % restocking fee + postage costs). • Upload up to 3 photos and 1 short video. • See key conditions automatically: 30-day limit from delivery (requests outside this window are rejected instantly), 20 % restocking fee on change-of-mind or mistaken orders, insurance premiums are non-refundable, and if the original spend was over $300 with free shipping, that outbound freight must be deducted from any refund. • Print the completed form so they can include it in the return parcel. The printout needs to show every field clearly so our warehouse can match the item to the request. On my side I want a clean, responsive layout that matches each store’s branding, works with the standard Shopify theme editor, and drops submissions into my admin panel/email with any attachments intact. A simple way to adjust fees or wording later through the theme customiser (or a quick code comment) would be ideal. Please build, test and deploy the form on both stores, then demonstrate that the date validation, fee notices and print view work as described.