OFFER TO PURCHASE AND CONTRACT OF SALE
(Continued on Reverse)
PURCHASE OFFER NO:
OMB Control No. 2900-0029
Respondent Burden: 20 Minutes
SUPERSEDES VA FORM 26-6705, OCT 1997,
WHICH WILL NOT BE USED.
VA FORM
FEB 2005 26-6705
SECTION I - PURCHASER(S) INFORMATION
2A. NAME OF PURCHASER
INSTRUCTIONS TO BROKER - Follow the instructions of the Service Provider to submit offer.
The "Conditions of Sale" on the reverse of this Offer to Purchase and Contract of Sale and any required Attachments and Addendums to it executed by the purchaser(s)
are incorporated herein and are a part hereof. All parties hereto acknowledge they have read and understand the "Conditions of Sale" on the reverse of this Offer to
Purchase and Contract of Sale (and any required Attachments and Addendums) as evidenced by their signature(s) herein below.
( )
SECTION III - ACCEPTANCE BY THE DEPARTMENT OF VETERANS AFFAIRS
Acceptance of this offer is hereby evidenced by my signature below and by the return to the Purchaser or Sales Broker of a copy hereof, so signed. (If the offer is not accepted it will
not be signed in Item 14A on behalf of VA and the prospective purchaser will be notified of the rejection.)
2B. ADDRESS OF PURCHASER (Include No., Street or rural route,
City or P.O. Box, State and ZIP Code)
3D. BUSINESS PHONE
(
)
1B. PROPERTY IDENTIFIER
3C. HOME PHONE
( )
3B. ADDRESS OF PURCHASER (Include No., Street or rural route,
City or P.O. Box, State and ZIP Code) (If same as above write "SAME")
3A. NAME OF PURCHASER
1A. ADDRESS OF PROPERTY TO BE PURCHASED (Include No., Street or rural route, City or P.O. Box, State
and ZIP Code)
4. STATE EXACT NAME(S) IN WHICH TITLE IS TO BE CONVEYED
5A. IS ANY PURCHASER A VETERAN?
YES
NO
(If "YES", complete Items 5B and 5C)
5B. SERVICE/SERIAL NUMBER
5C. DATES OF LATEST SERVICE
$
N. INTEREST RATE
I. CASH EQUIVALENT VALUE OF
TOTAL OFFER (Item E + Item H)
YES
NO
B. ANY PERSON WHO HAS BEEN EMPLOYED BY THE SERVICE PROVIDER OR ANY OTHER ENTITY UNDER COMMON OWNERSHIP
WITH THE SERVICE PROVIDER WITH