REQUEST INFORMATION

Thank you for your interest! The Robert S. Maseychik Insurance Agency proudly offers an array of insurance products for you and your family. To learn more about the lines of insurance listed on the compaines page, simply complete the following form and the policies that you'd like to learn more about.

We will be sure to contact you to discuss these policies and send you additional information about them. Thank you, again!

NOTE: Required entries are marked by *

* Name/Company: 
* Address:    (Property Address)
Address2: 
* City: 
* State: 
* Zip/Postal: 
* Phone (Home): 
Phone (Work): 
Cell: 
Fax: 
* E-Mail: 
 
* Preferred Method of Contact: 
 
I am interested in the following product: (check all that apply)
Home and Other Property
Vehicle - All Types
Business
Financial
Life
    Other:     
Current Policy Status:    Yes - I have a current policy   No - I do not have a policy
Policy Renewal Date:   
Ins. Details/Question/Comment:  

  

Please only click the Submit button once to place your request

Robert S. Maseychik Insurance
1016 Pittston Ave, Suite 201
Scranton, PA 18505
(570)348-3731
Fax: (570)348-3766
1-800-843-4846 (570 area code only)
rmaseychik@weinsure.net

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