What is the best way to ask a user for contact information on an exit survey?

We currently have an exit survey on our site that is triggered when a customer attempts to exit the purchase flow. We've been getting vague responses back and would love to contact some users to get more information on their issue. My solution is to add "Company can contact me regarding my survey response" or possibly "May we contact you to follow up on your response?" followed by an email or phone number input field.

sample exit survey with contact request

The CX team worries that:

  1. users will expect a response to their issue
  2. users will use this a de-facto contact form for customer service.

I feel these both these concerns will be negated by the context and wording of the survey

  1. survey only shown to a user as they attempt to leave purchase flow
  2. wording clearly states that: a) contact is limited to the user's response to the form, b) is optional for the user to participate, c) user contact is per our discretion

My question then is what is the best way to request a user to provide their contact information on an exit survey so that we may improve the site's UX?

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