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Personal Information
First Name
MI
Last Name
Suffix
Social Security Number	 -   -
Date of Birth(MM/DD/YYYY)	 -   -
Email Address
Re-Enter Email Address
Mother's Maiden Name(Last Name Only. example; Smith or Jones)
Address Information
Current Address
Apt.#,Bldg.#, etc
City
State
Zip Code
Residence Type
Monthly Mortgage/Rent Amount
Home or Cell Phone Number	 -   -
Employment Information
Employer Name
Work Phone Number	 -   -
Annual Income*
 	Enter your annual income. * 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.
Consent to Electronic Disclosures
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By consenting to receive information electronically at our web site, you will receive your notice of credit decision or adverse action letter related to this application electronically.


You may not apply online unless you accept these disclosures and information electronically.


By consenting below, you may also receive other information, such as collection notices or other legally required disclosures electronically. We will notify you prior to commencement of providing any such documents electronically.

By consenting to receive information electronically you verify that:
- To receive this information electronically, access, and retain any disclosures received, you will need a desktop or laptop personal computer with a minimum web browser that supports 128 bit encryption. You must also have ability to receive and read email.
- You (i) agree to receive disclosures electronically and confirm that you will download or print the disclosures for your records, (ii) acknowledge that you can access information that is provided electronically at this web site, (iii) acknowledge that such action constitutes your signature to the credit application and agreement to these terms and conditions, and (iv) acknowledge that you are providing your consent to receive electronic communications pursuant to the Electronic Signatures in Global and National Commerce Act and intend that this statute applies to the fullest extent possible.
Important Notice:
You understand that the information you have elected to receive is confidential in nature. We are not responsible for unauthorized access by third parties to information and/or communications provided electronically nor any damages, including direct, indirect, special, incidental or consequential damages caused by unauthorized access. We are not responsible for delays in the transmission of any information. We are not responsible for any computer virus or related problems. If your e-mail address changes, you are required to notify us. If you have questions about these disclosures, you may contact us:
- Existing Cardmembers: Call the customer service number shown on your billing statement or the back of your card.
- Customers applying for credit: Call 1-877-277-0948.
Alternatively, you may request to receive specific information in paper form:
- Existing Cardmember: Please call the customer service number shown on your billing statement or the back of your credit card or write to the customer service address shown on your statement.
- Customers applying for credit: Call 1-877-277-0948 or write to HSBC Card Services, PO Box 80084, Salinas, CA 93912-0084
In addition, once you receive notice from us that we will commence sending other information electronically, such as, application disclosures, Privacy Notice, Cardmember Agreement and Disclosure Statement, billing statements and collection notices, you may withdraw your consent to our providing such other information electronically at any time. To receive other information in paper form and/or to withdraw your previously provided consent, please contact us as indicated above. Please specify the information you wish to be provided in paper form and/or to which your withdrawal of consent applies. Your request will only apply to those specific items of information designated by you.
	* I consent to receive information electronically.
Optional Debt Protection
Check "Yes" if you want Personal Account Protection Elite, an optional program, to freeze the balance on this Account in the event of involuntary unemployment, disability, identity theft and much more.

Enroll today to protect this credit card with a 30-day money back guarantee.

Terms and Conditions Details
	 Yes, please enroll me in Personal Account Protection Elite (optional).
	To Complete Enrollment: By initialing here   and submitting this application, I am providing electronically signed election to enroll in the optional Personal Account Protection Elite monthly debt protection program. I have reviewed important program terms and conditions. I understand a monthly charge will be applied to my Account when there is a balance, and that I am free to cancel this optional enrollment at anytime.
	 No, I do not want to protect this Account at this time.



If you're experiencing technical difficulties while applying on our website, please call Technical Support at 1 (877) 277-0948 6:00am to 5:00pm PT Monday-Friday.
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