Your startup should clone the "Send Feedback" feature of Google Plus
This is a great tool, and makes me want to send feedback to Google. It just abolished the cognitive load it takes to send my feedback to the Google.
At the moment it is a more traditional bug tracker, but the side widget is designed to accept anonymous feedback in this sort of form as well (coming soon).
But I don't think it's that intuitive to black the info out. I've sent a few blackouts already and I didn't even realize I should black out the info. I didn't know I could do that until I saw someone else do it. So I think they need to make that part a lot more obvious.
Someone should offer it as a service instead.
(Also allows you to black out personal information, but the blackout in the second pic, I did.)
Then allows you to add notes and submit meta data.
Edit 2 - Better pics:
Click on the cog at upper right => choose "Send Feedback"