VA Loan Form
Property Information
Property State	Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Approximate home value	Select... under $60,000 $60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$220,000$240,000$260,000$280,000$300,000$320,000$340,000$360,000$380,000$400,000 over $400,000
How much do you currently owe on your home?	Select... under $60,000 $60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$220,000$240,000$260,000$280,000$300,000$320,000$340,000$360,000$380,000$400,000 ?> over $400,000
What is your desired loan amount? (optional)	Select... under $60,000 $60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$220,000$240,000$260,000$280,000$300,000$320,000$340,000$360,000$380,000$400,000 over $400,000
Current Interest Rate	Select... under 3% 3.1%3.2%3.3%3.4%3.5%3.6%3.7%3.8%3.9%4%4.1%4.2%4.3%4.4%4.5%4.6%4.7%4.8%4.9%5%5.1%5.2%5.3%5.4%5.5%5.6%5.7%5.8%5.9%6%6.1%6.2%6.3%6.4%6.5%6.6%6.7%6.8%6.9%7%7.1%7.2%7.3%7.4%7.5%7.6%7.7%7.8%7.9%8%8.1%8.2%8.3%8.4%8.5%8.6%8.7%8.8%8.9%9%9.1%9.2%9.3%9.4%9.5%9.6%9.7%9.8%9.9%10%
Reason for Refinancing	Select... Cash Out Lower My Monthly Payment Lower My Interest Rate Home Improvement Debt Consolidation Other
Have you ever filed for bankruptcy?	Select... Never Currently Within the year 1-2 years ago 2-5 years ago 5-7 years ago Over 7 years ago
Rate your credit	Excellent   Good   Fair   Poor
Are you eligible for a VA Refinance?	Yes   No   Not sure
Personal Information
First name:
Last name:
Address:
City:
State:	Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip code:
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Alternate Phone number: (optional)
E-mail:
Privacy:	By checking this box, I agree to VLC's privacy policy and terms agreement.

Customer Testimonials
"Amy, I cannot tell you how much my wife and I appreciate all of your efforts. It is easy to see why people think so much of your branch.

Your friendliness, professionalism, knowledge and the ability to make us feel like a member of the family will not go unnoticed, and is appreciated. Again, thanks ever so much."

- Wayne Hamilton

"Thank you so much for all your hard work. We are very pleased with your company and all of its hard working employees. Take pride, you deserve it.

Donna and I want to thank you from the bottom of our heart on a job well done. You are great at what you do, pleasing the customer. You are a great person to know, and we thank you."

- Paul Watkins