Service Request Form

Your Name*

First NameLast Name

Email Address*

example@example.com

Phone number*

Enter your contact number.

Property Location*

Street Address

Apt or Building Number

CityStateZip CodeCountry

Select the service(s) that fits your need.*

What type of property is this?*

What is your relationship to the property?*

Urgency level*

Emergency (Active Urgent Issue)High (Within 24–48 Hours)Standard (Next Available)

Is the property occupied?*

YesNo

Is this related to an insurance claim?*

YesNo

Preferred appointment time*

Tell us what happened

Attach photos or files here

Upload any photos of the affected area or documents (insurance letters, inspection notes, etc.).

How did you hear about us?*

Signature*

Disclaimer

By submitting this form, you acknowledge and agree that SHIELD Atlantic provides mitigation, moisture control, and property protection services only. We do not provide licensed general contracting, structural repairs, engineering evaluations, or rebuild services, and no information supplied by SHIELD Atlantic should be interpreted as such.

All assessments are based solely on the conditions visible and accessible at the time of inspection. They are not comprehensive structural, mechanical, electrical, or plumbing evaluations. Hidden or latent conditions may exist and may be discovered only after mitigation begins. SHIELD Atlantic is not responsible for damage or conditions that existed prior to our arrival or that are discovered after work begins.

Emergency response times and service availability are based on technician access, location, weather, and safety considerations and cannot be guaranteed. Submitting this form does not create a contract for services until your appointment is confirmed by SHIELD Atlantic.

By providing your contact information, you authorize SHIELD Atlantic to contact you by phone, text message, email, or automated communication systems for scheduling, updates, service coordination, and other property-related communications.

SHIELD Atlantic may use secure, industry-standard software tools, including AI-assisted systems, to support scheduling, documentation, communication drafting, record organization, or quality assurance. These tools do not replace human judgment, and all decisions and services are reviewed and performed by qualified personnel.