Present this form to your Sales Manager at your first visit. First Name Last Name Community Address City State --Select a State-- Alabama Alaska Arizona Arkansas California Colorodo 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   Daytime Phone E-mail     * Repeat buyer payment is in the form of options chosen through the Van Metre Design Center and applied toward the purchase of a new Van Metre Home. This offer may not be used in conjunction with any other discount, coop brokerage fee or referral program. Program not available with use of a Realtor. This is a limited-time offer and may be withdrawn at the discretion of Van Metre Homes without prior notice. Incentive available only with use of Seller¹s designated Lender and Title company. Repeat/Referral forms must be presented at time of contract. Effective January 15, 2006.