Order Form

In addition to completing the order form below, please fill out our required AUTHORIZATION & LIABILITY AGREEMENT and return to mary@mleblanc.com. Thanks!

Manager's Name *
Manager's Name
Ordering Manager
Manager Telephone #
Manager Telephone #
Product Type *
Sales Agent Name *
Sales Agent Name
Community Telephone
Community Telephone
Community Address *
Community Address
Appointment recommended?
Days Off *
Names and days on / off
Community *
Sales Office
Profile demographics and average income
From: Low $ to High $
Agreement *
A 50% non-refundable deposit retainer is required prior to field scheduling. In consideration of this service, Client agrees to indemnify and hold harmless, LeBlanc & Associates along with members of its staff or subcontractors, from any claims or causes of action arising out of this salesperson evaluation, especially in the case of recording the evaluation encounter. Should the salesperson not be present on the specified day or the evaluation is incomplete beyond the control of LeBlanc & Associates, Client agrees to pay quoted attempt fees to cover the costs of the evaluator’s time and mileage and expenditures incurred by LeBlanc & Associates.
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