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Xtreme Assurance Claim Form

  Some restrictions apply:
  • Xtreme Assurance claims must be filed within 15 days from the last day of the window.
  • Xtreme Assurance claims can only be filed by the debtor of the freight bill.

  • *Required Fields
    *Claimant Name
    *Company Name
     *Street Address
    *City *State *Zip
    *Claimant Telephone
    *Claimant Email Receipt will be sent, if valid.
    *Pro Number (11 digit, numbers only)
    Other Information Please include any other information that will help us research this for you.
    *Preparer Name
    *Preparer Telephone