Visa Debit Card Application by sofiaie

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									                                                                                  Visa Debit Card Application Form
                                                           Complete the form using a BLACK PEN and print in clear CAPITAL LETTERS

 Complete this form to apply for an HSBC Visa Debit Card or to link an extra account to your existing Visa Debit Card.

          Post the completed form to:                 GPO Box 5302, SYDNEY NSW 2001 or FAX to 1300 765 150

                                                                     CUSTOMER DETAILS
Applicant 1                                                                      Applicant 2
Customer number                                                                  Customer number



                                                                     NEW VISA DEBIT CARD

        I would like to apply for a new Visa Debit Card and link the following accounts
     I would like to apply for a new HSBC Premier Debit Card (available with the HSBC Premier Cash Management
     Account and HSBC Premier Children’s Saving Account) and link the following accounts
Applicant 1 Primary Account Number                           Applicant 2 Primary Account Number



You can access your “Primary Account” at an ATM or EFTPOS terminal by selecting the “CR” (Credit) or “SAV” (Savings)
button or by using your 16 digit Visa Debit Card number for purchases made over the internet, phone, or mail.
Applicant 1 Secondary Account Number                                             Applicant 2 Secondary Account Number



You can access your “Secondary Account” at an ATM or EFTPOS terminal by selecting the “CHQ” (Cheque) button.
                                  LINKING A SECOND ACCOUNT TO AN EXISTING VISA DEBIT CARD

        I would like to link a second account to my existing Visa Debit Card
Visa Debit Card Number                                                           Visa Debit Card Number

    I    I    I    I    I     I    I    I    I    I    I     I   I     I   I       I   I     I   I   I   I   I   I   I   I   I      I   I   I   I

Applicant 1 Secondary Account Number                                             Applicant 2 Secondary Account Number



                                                                           SIGNATURE
By signing this application, I/we acknowledge the I/we have received and understood the Personal Savings and Deposit Account Product
Disclosure Statement and if I/we have a home loan, the HSBC Home and Investment Property Loans Booklet of Terms and Conditions
applicable for this service. Further, I/we provide the acknowledgements, consents and authorisations required of me/us as detailed within the
Personal Savings and Deposit Account Product Disclosure Statement and if I/we have a home loan, the HSBC Home and Investment Property
Loans Booklet of Terms and Conditions. I/we specifically acknowledge that in processing my/our application HSBC will deal with my/our private
information in the manner detailed within the Personal Savings and Deposit Account Product Disclosure Statement and if I/we have a home loan,
the HSBC Home and Investment Property Loans Booklet of Terms and Conditions.
Applicant 1                                                                     Applicant 2
Surname                                                                         Surname


First Name                                                                       First Name


Signature                                             Date                       Signature                                   Date




                                                                     INTERNAL USE ONLY
Staff signature                                                                 Date
                                                                                                                                                    HBAA828VDC 11/09




Staff name



Issued by HSBC Bank Australia Limited ABN 48 006 434 162 AFSL No. 232595

								
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