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(if different from Residence)
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* Obtaining Your Card: The USA PATRIOT Act is a federal law that requires all financial institutions to obtain, verify and record information that
identifies each person who opens a Card Account. What this means for you: When you open a Card Account, we will ask for your name, address,
date of birth and other information that will allow us to reasonably identify you. We may also ask to see your driver's license or other identifying
documents at any time. "Guaranteed approval" is contingent upon successfully passing this mandatory identification information. This card is issued by Choice
Bank Ltd pursuant to license by MasterCard International Incorporated. MasterCard is a registered trademark of MasterCard International Incorporated.