Law Offices of LeBlanc, Karlseng & Patten, PC

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Place Order | Appraisals | Calculators

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Place Your Order - New User

Welcome! We do not have an account currently set up for you. Simply fill out the order form below and when you submit it an account will automatically be set up. This means that if you return to fill out this form again in the near future, you will be able to access it as an existing user by using your email address, and many of the fields will auto populate with your previously entered information. Fields marked with an asterisk * are required.

User Info

*Branch:

*Your Email Address:

*Password:

*Name:

*Company:

*Title:

*Phone:

*Fax:

Mobile:

Secondary Contact Title:

Phone:

Fax:

Mobile:

Email Address:

Type of Request

Regular Refinance - No Cash Out
Home Equity Refinance - Cash Out
Investment Property Refinance
Purchase/Sale

Loan Info Loan Amount:

Property Address *Address:

*City:

State:

*Zip:

County:

Legal Description :

Borrower Info *Name:

Social Security Number:

*Address:

*City:

State:

*Zip:

Phone Number:

Fax:

Email:

Co-Borrower Info *Name:

Social Security Number:

Contact information same as borrower.

*Address:

*City:

State:

*Zip:

Phone Number:

Fax:

Email:

Miscellaneous

Do you have a Sales Rep?�

Yes

If yes, who?

Additonal Comments

Seller Information * Seller's Name:

Social Security Number:

Address:

City:

State:

Zip:

Phone Number:

Fax:

Email:

Co-Seller Name:

Social Security Number:

Address:

City:

State:

Zip:

Phone Number:

Fax:

Email:

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