Personal Information First Name: FREDERICK MI: K Last Name Name: TUDOR Suffix: Current Address: 6535 IMPERIAL

AVE Apt.#,Bldg.#, etc: City: SAN DIEGO State: CA Zip Code: 92114 Residence Type: OWN Home or Cell Phone Number: 619 - 581 - 1123 Social Security Number: 552 - 31 - 8458 Date of Birth(MM/DD/YYYY): 08 / 17 / 1964 Mother's Maiden Name(Last Name Only. example; Smith or Jones): MATLOCK Married: Employer Name: CENTERPLATE Work Phone Number: 619 - 525 - 5898 Annual Income* $: 20000 Personal Account Protection: NO Email Address: KEITHWITHKITTY@YAHOO.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 : MKTCELL010 RRU MEDIA : O8EM098AAA1202111572XHHHBGlobalUniqueID=107703226

Additional Information Employer Name: Employer Address: Employer Phone:

____________________________ ____________________________ ____________________________

Occupation/Nature of Business: Length of time at Present Employer:

____________________________ ____________________________

Annual Income from Present Employer:$___________________________ Other Annual Income Source of Other Income: $___________________________ ____________________________ ______ United States ______ Other ____________________________ ____________________________

Citizen of Country of Citizenship, if Other, : Length of time at Present Address:

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. 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 to open and grant to us a security interest in a Deposit Account with HSBC Bank USA, National Association. 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 my secured credit card account, I 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. I agree that HSBC Bank Nevada, N.A. will use this account as collateral for my secured credit card account. I agree that this security interest includes and give the exclusive right to HSBC Bank Nevada, N.A. to redeem and collect and withdraw any part of the full amount of the Savings Account as provided by the Cardmember Agreement and Disclosure Statement, which will be sent to me with my card. Backup Withholding: 1. Under penalties of perjury I certify that the social security number I provided is my correct Taxpayer Identification Number. 2. I also certify that I am not subject to backup withholding because (a) I am exempt from backup withholding; or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me that I am no longer subject to backup withholding. 3. I also certify that I am a U.S. person (including a U.S. resident alien). (If you have been notified by the IRS that you are currently subject to backup withholding due to an underreporting of interest or dividends, please cross out item 2 above.) BY SIGNING BELOW, I agree to these terms and I agree to open a savings account with HSBC Bank USA, National Association for at least $200 and understand a Truth in Savings Disclosure will be mailed to me when my savings account is opened. The IRS does not require my consent to any provision of this document other than the certifications required to avoid backup withholding. I understand and agree that I am granting a security interest to HSBC Bank Nevada, N.A. in my 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. * Viewing PDF files requires the use of Adobe Reader

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

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