VA Application Please note that all fields followed by an asterisk must be filled in. Property State*
---Select--- • Florida
• New Jersey
• Connecticut
County of subject property*
How did you hear about us*
---Select--- Internet
Realtor
Referral
Other
If Realtor - Realtor's Name
Do you have your Certificate of Eligibility*
---Select--- Yes
No
Property Type*
---Select--- Single Family Detached
Townhouse
Condo w/4 or fewer stories
Condo w/4 or more stories
Multiple Family Dwelling
Coopertive
Modular
Mobile/Manufactured Home
ZIP code of property*
Use of property *
---Select--- Primary Home
Secondary Home
Investment Property
Is your current mortgage a FHA & VA loan *
---Select--- Yes - Current mortgage is FHA & VA loan
No
Are you requesting a loan with a spouse or co-borrower*
---Select--- No co-borrower
Spouse
Other co-borrower
If yes, co borrower first name
Your middle initial
Co borrower Last name
Please choose a suffix
---Select--- Sr.
Jr.
I
II
III
Co borrower Address Co borrower social security number
Co borrower date of birth
What interest rate do you have now*
Fixed rate or Adjustable
---Select--- Fixed rate
Adjustable rate
Current loan balance - How much do you owe now*
Have you had a mortgage late payment in the last 12 months
---Select--- Zero late payment
One time late
More than one time
Your first name*
Your middle initial
Your last name*
Please choose a suffix
---Select--- Sr.
Jr.
I
II
III
Daytime/Work Phone*
Evening Phone*
Cell Phone*
What is your email address*
Property address*
City*
State*
ZIP code*
How long have you lived at this address*
---Select--- Less than 2 years
More than 2 years
Date of birth*
Marital status*
---Select--- Married
Not Married
Divorced
Separated
Citizenship status*
---Select--- US Citizen
Permanent Resident Alien
Non-Permanent Resident Alien
Non-Resident Alien
Social Security #*
What is your monthly housing payment*
Annual Premium Homeowners Insurance*
How much are your property taxes a year*
Please tell us about any special circumstances that may apply to your loan request and/or the best time for us to call you:
