VA Refinance Application (651) 552-3681
Borrower Basic Information 

 * = Required Information

Is there a co-borrower? No   Yes  
  If yes, co-borrower information can be entered on the next page but include their assets (checking/savings) on this page.  
  Co-borrower name   
Your FULL Name (First, MI, Last) *  
Email address *  
Best Phone # *    Home or Cell
2nd best phone # 
  Home or Cell
* Work Phone #  (REQUIRED for verification of employment)  
Current Address *    
  State  Zip    
How long have you lived here  years  months  
Do you currently  
Old Address
(Only if at current less than 2 years)  
  State  Zip  
Rent or Own .  
  How long did you live there  years  months  
Date of Birth (format mo/da/year)  Required  
Social Security Number  Required  
Credit Score  
  Ever File Bankruptcy?   
   If Yes, How long discharged? Years  
  Ever have a foreclosure?   
   If Yes, How long discharged?  Years  
Marital Status  
Years of Schooling  
Any dependents?   No  Yes  
   If yes, how many? . Ages   

Military Information

Are you or co-borrower US Military?  
Current Status  
If discharged, type  
Ever had a VA loan before  
  If Yes, did you default on the loan  
Have your Certificate of Eligibility  

Borrower Employment

  State  Zip   
Position/Title with Company  
Time with Current Employer  Years  Months  
How long in this line of work? Years  
Are you self employed?  
Former Employer (if less than 2 years with current employer)  
  State Zip  
  You worked there from when to when mo /yr until mo / yr  
  Old Income , per   
  Former Position/Title   

Contacting You

We usually attempt to contact you between 10:00 AM & 6:00 PM Monday - Friday. 
If we are unable to contact you during this time frame, it could delay your application.
Daytime Contact  at   

Basic NEW Loan Information

Purpose of new loan  
Type of Loan (Fixed, ARM)   
Amortization Term:  10 yr - 30 yr available  
Estimate Loan Amount Needed $  
Property will be our  

Current Loan Information

Your Current Monthly Payment is: $   
  Does this include escrows? YES   NO  
Your Current Interest Rate? %.  
Current Mortgage Company Name?   
Current loan type?  
Do you escrow? YES NO  
Escrow Information: Property Taxes $  
  Homeowners Insurance $  
About this property? Year purchased? .  
  What was the original cost? $  
Today's Estimated Value $  
Estimated Remaining Balance $  
Do you have PMI on your loan? YES NO   
Have a 2nd Mortgage/Equity Loan?  YES NO   -  
  If yes, how much do you still owe? $   
  If yes, what is the payment?  $  
Keep or consolidate 2nd mortgage? Keep Consolidate  
How to pay closing costs?  

Subject Property Information:

Subject Address  Same (skip next)  
   State  Zip  

(we lend in MN, WI, and SD only)


Monthly Income:

Gross Monthly Income (Pre-Tax)  
Base Income $  per   
Net Rental Income  
Other  (Child Support, Social Security, Pension, etc)
Explain Income 

Assets: (Include all Applicants)

(includes checking, savings, stocks, mutual funds, etc.) (Include all Applicants Assets)  
Account 1 $ Name of Bank   
Account 2 $ Name of Bank   
Account 3 $ Name of Bank   
All additional accounts $  
Stocks and Bonds $ Name of Bank   
401(k)/Retirement $  
Net Worth of Businesses Owned $  
Automobiles Owned 1 Yr/Make. Estimated Vale $   
Automobiles Owned 2 Yr/Make. Estimated Vale $   


Who do you owe? (Include all Applicants debts)  
Current 1st Mortgage Co
 or Landlord Name
. Monthly payment   
Current 2nd Mortgage Co . Monthly payment   

Alimony/Child Support

All other debts of ALL applicants (car loans, credit cards, student loans, etc) List only minimum required monthly payments
$month.  Total unpaid balance(s) $

Own Other Properties:

Own any other property NO YES  
If "Yes" - What is it worth? $ How much do you owe on it? $  

What is the payment?

First other property address    
  St  Zip  
Second other property address    
  St   Zip  


A. Are there any outstanding judgments against you?  
B. Have you been declared bankrupt within the past 7 years?  
C. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?  
D. Are you a party to a lawsuit?  
E. Have you directly or indirectly been obliged on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure or judgment?  
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?  
G. Are you obligated to pay alimony, child support, or separate maintenance?  
H. Is any part of the down payment borrowed?  
I. Are you a co-maker or endorser on a note?  
J. Are you a U.S. citizen?  
K. Are you a permanent resident alien?  
l. Do you intend to occupy the property as your primary residence?  
M. Have you had an ownership interest in a property in the last three years?  
(1.) What type of property did you own Principle residence (PR), second home (SH), or investment property (IP)?  
(2.) How did you hold title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?  


Information for Government Lender Monitoring purposes  
 I do not wish to answer  
Ethnicity:  NOT Hispanic or Latino
Hispanic or Latino
Gender  Male   Female  

Other Information:

Please write in any other information you feel is important to us making our decision, or answers to any YES questions in the declarations section.  
How did you find out about us   
This help's keep our advertising dollar effective, therefore reducing YOUR closing costs!





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