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To Complete the Application Process :

1. Complete and print the Application, which includes all of the information
   you provided to us on the inquiry form.
2. Sign, date and initial the Application.
3. Send your signed Application and your security deposit (minimum $200)
   as a check or money order, payable to HSBC Bank USA, N.A.,
   to the following address:
   HSBC Bank USA, N.A.
   PO Box 4045
   Buffalo, NY 14240

Deposit products offered by HSBC Bank USA, N.A. member FDIC.

If you have any questions about the Secured credit card, please call us at 1-877-277-0948.

First Name:	MOMODOU
MI:	K
Last Name Name:	BAH
Suffix:
Current Address:	3803 HANOVER STREET
Apt.#,Bldg.#, etc:
City:	MADISON
State:	WI
Zip Code:	53704
Residence Type:	RENT
Home or Cell Phone Number:	757 - 319 - 9929
Social Security Number:	389 - 19 - 4356
Date of Birth (MM/DD/YYYY):	01 / 31 / 1976
Mother's Maiden Name (Last Name Only. example; Smith or Jones):	JALLOW
Married:	NO
Employer Name:	UW MADISON
Work Phone Number:	757 - 319 - 9929
Yearly Household Income* $:	50000
AccountSecure® PLUS Credit Protection:	NO
Email Address:	KABABAH@HOTMAIL.COM

* Alimony, child support and separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

Bank Use Only : MKTCELL020 RRJ MEDIA : O8EM032AAX0811000846XXTTBCD102

 

Occupation:	____________________________
Length of time at Present Employer:	____________________________
Annual Income from Present Employer:	$___________________________
Other Annual Income ¹:	$___________________________
Source of Other Income:	____________________________
Citizen of ²:	______ United States ______ Other
Country of Citizenship, if Other, :	____________________________
Length of time at Present Address:	____________________________

¹ Alimony, child support and separate maintenance income need to be disclosed if you do not wish to have it considered as a basis for repaying this obligation. ² Required only to open the Deposit Account. This information will not be used to open the credit card account.

By signing below, you understand and agree to the following: You must be of at least legal age in the state of your residence and have a telephone in your home to be eligible. All of the information you have provided on the inquiry form has been transferred to this application form and that information is complete and accurate and given to obtain credit. You understand that HSBC Bank Nevada, N.A. ("HSBC", "we", "us") will retain this application. You authorize us to obtain a credit report on you and to verify the information from whatever source we choose. You are requesting a credit card issued by us and if a credit card is issued to you, by using or permitting another person to use the credit card, you agree to be bound by the terms and conditions of the Cardmember Agreement and Disclosure Statement, including any amendments thereto, ("Cardmember Agreement") that will be sent to you with the card. This application is a contract only when accepted in Nevada by us. You understand that by applying for the Orchard Bank Secured MasterCard, you are agreeing you will be opening and granting to us a security interest in a Deposit Account with HSBC Bank USA, National Association, governed by the Secured Credit Card Deposit Account Control Agreement, which you will be asked to sign. This application and our Cardmember Agreement will be governed by federal law and the laws of the state of Nevada even if the MasterCard credit card is used outside of Nevada. You acknowledge you have read and agree to the Terms and Conditions of the Orchard Bank Secured MasterCard credit card.

Security Agreement: As security for repayment of all credit extended or to be extended through your secured credit card account, you understand and agree to establish and maintain a Savings Account at HSBC Bank USA, National Association with a minimum balance of $200, which will secure the repayment of all obligations under the secured credit card account. You agree that HSBC Bank Nevada, N.A. will use this account as collateral for your secured credit card account. You agree that this security interest includes and gives the exclusive right to HSBC Bank Nevada, N.A. to redeem and collect and withdraw any part or the full amount of the Savings Account as provided by the Cardmember Agreement and Disclosure Statement, which will be sent to you with your card.

BY SIGNING BELOW, you agree to these terms and you agree to open a savings account with HSBC Bank USA, National Association for at least $200.
You acknowledge that the Savings Account will not be established until all completed documents are received by HSBC Bank USA, N.A. and processed. You understand the Savings Account number will not be assigned until the Savings Account is opened.

You understand and agree that you will be granting a security interest to HSBC Bank Nevada, N.A. in your Deposit Account with HSBC Bank USA, National Association. __________ (Applicant's Initials)


Applicant's Signature: _________________________________

Date: ____ / ____ / ____

This application will not be processed without your initials and signature.

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(Maintain the following for your records. Do not return this portion with your application.)