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Residential Service Request

Please take a moment to fill out the form below. A Central Roofing representative will review your request and respond shortly with more information.

* Required feild
If you do not know or the information in the required fields do not apply to you, please type n/a.

Homeowner *

Physical Address: *

Mailing Address: *

City/Zip: *

Contact Number: *

Contact Email: *

Room Area Nature of Problem*

Service Details

* Required feild

Roof Type: *


Home Square Footage: *

Onsite Contact Name: *

Last Re-Roof/Repair:

Performed By:

Pitch of the Roof:

Onsite Contact Number: *

*By submitting this service request, you are stating you are authorized to request and approve repairs and payments for said repairs at the areas shown above. Once we have received your completed request, you will be contacted with a 2 hour appointment window. Please be aware, our service crews may require access to the leak area and/or attic during the inspection. All pets should be locked away from these areas during the inspection. An inspection report charge based on square footage will be due at the time of the service inspection. This will be invoiced to you via the email provided. This amount will be credited on your repair invoice should you choose to use us for your repairs. All service repair charges are due on receipt. A 4% fee is added for all credit card payments. An initial late fee of 10% will be assessed if not paid in full within 10 days of completion and an additional 30% will be assessed for any amounts not paid in full within 30 days. Lien notices will be issued on any payment outstanding after 30 days and all legal / attorney fees will be added to the balance due.