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Year</option></field><field type="checkbox-group" name="high-risk-activities" label="Do you engage in any of the following sports or activities?"><option value="Scuba diving ">Scuba diving </option><option value="Hot air ballooning ">Hot air ballooning </option><option value="Mountain climbing">Mountain climbing</option><option value="Motor/speedboat racing ">Motor/speedboat racing </option><option value="Bungee jumping ">Bungee jumping </option><option value="Hang gliding ">Hang gliding </option><option value="Sky diving ">Sky diving </option><option value="Rock climbing ">Rock climbing </option><option value="Horse racing ">Horse racing </option><option value="High diving ">High diving </option><option value="Aircraft piloting">Aircraft piloting</option><option value="Frequent international traveling">Frequent international traveling</option></field><field type="textarea" name="comments" placeholder="Please include any details or comments regarding this quote request" 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I been a policy holder at SHAPIRO INS for 15 years. Every single one of the agents are always willing to help me. Friendly, respectful, couldn’t ask for any better. I always make comments (I will never leave) but is true. Recently I just walked in to make a payment and they checked my policy and I got to save a lot money, I mean a lot money. Thanks again (Juan Burgos and Ms. Lisabeth). ?

— Luis L.

	8382 Baymeadows Road, Suite #2 Jacksonville, Florida 32256
	800.563.5467
	info@insuresig.com
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