Extreme Sports Insurance Co.

Claim Process

Fill out our form below to initiate your claim process for that totally-not-your-fault injury you sustained while attempting to break the world record for most consecutive backflips on a skateboard.

Claimant Information:

Your Name: Date of Injury: Description of Injury: <label for="video_proof">Video Evidence (optional):</label> <input type="file" id="video_proof" name="video_proof"> <button type="submit">Submit Claim</button> </fieldset> <fieldset> <legend>Witness Information:</legend> <label for="witness_name">Witness Name:</label> <input type="text" id="witness_name" name="witness_name"> <label for="witness_contact">Contact Information:</label> <input type="text" id="witness_contact" name="witness_contact"> <label for="witness_statement">Witness Statement:</label> <textarea id="witness_statement" name="witness_statement"> </fieldset> </form> <p><a href="/subpages/insurance/coverage/accident-reimbursement/">View Coverage Options</a></p> <p><a href="/subpages/finance/insurance/coverage/extremesports/claim-status/">Check Claim Status</a></p> </div> </body> </html>