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  Thank you for taking the time to fill out this refinance application. We value your privacy and our web-site is secure. However, if you would prefer not to include your social security number in this web-based form, then please leave the section blank and call our toll free number to complete the application.
  refinance APPLICATION:*(Required information please fill out completely)  
  loan information First Second (if applicable)
  Mortgage Balance* $  
  Mortgage Term*    
  Mortgage Rate* %  
  Additional amount to borrow* $    
  Estimated Value* $    
  (Help find Home Value)        
  TYPE OF LOAN (select up to 4): (Get Descriptions)
  Fixed Rate: 15 year Fixed      
    30 year Fixed      
    40 Year Fixed      
  Adjustable Rate: 1/1 Fixed ARM 7/1 Fixed ARM  
    3/1 Fixed ARM 10/1 Fixed ARM  
    5/1 Fixed ARM    
  Interest Only Rate: 1/1 Interest Only 7/1 Interest Only  
    3/1 Interest Only 10/1 Interest Only  
    5/1 Interest Only    
  Other: Reverse Mortgage Negative Amortized Loan  
  BORROWER INFORMATION: *(Required information please fill out completely)
  Are you requesting a loan with a co-borrower?
  First Name:*    
  Middle Name:      
  Last Name:*      
  Date of Birth:*   /    /     
  Social Security No: - -      
  Current Mailing Address:      
  Street:*      
  Additional:      
  city:*      
  State:*        
  Zip Code:*        
  Daytime Phone:* (i.e.) 123-456-7890 Ext.  
  Evening Phone:* (i.e.) 123-456-7890 Ext.  
  Email Address:* Confirm Email Address:*
  Create a Password:* Re-Enter Password:*
  PROPERTY INFORMATION:      
  What state is the property in?*  
  Price of the home to be purchased* $ .00  
  Available Down Payment?* $ .00  
  Reason for purchase:*    
  Property Description:*    
  FINANCIAL INFORMATION:      
  Can you provide full documentation? Yes No  
  Monthly Pre-Tax Salary: $ .00  
  Additional Monthly Income: $ .00  
  Current Monthly
Housing Payment:
$ .00  
  Will Payments Continue After
New Home Purchase?
Yes No  
  COMMENTS:          
  please Add any Additional Comments Here:
(Up to 150 words)
  Disclosure:          
 
  Do you agree with the terms?   Yes No  
         
             
 
 

South Bay
Mortgage & Capital Inc.

2301 Rosecrans Avenue, Suite # 4120
El Segundo, CA 90245

Phone: (310) 536-5173
Fax: (310) 536-5174
CA Lic # 01521685

 
  Palisades Mortgage Group, LLC
2301 Rosecrans Avenue, Suite # 4120
El Segundo, CA 90245

Phone: (310) 536-0643
Fax: (310) 536-5174
   
 
Disclosures: