Here is an incomplete list of things you can do with your Karma Points, which are gained through regular play and not being a douche. The standard cost is going to be 100 Karma per item on this list.
Buying a Merit for your character. You must also spend Level of Merit x10 in XP for that character and it has to be approved by the STs (there needs to be a Story reason for it).
Playing something not on the list of ‘allowed’ clans. Examples: Gargoyle, Kaisyd, or Lasombra-Anti (Will still require a talk with the STs about concept approval.)
Creating an additional character within the same Venue.
Creating an exceptional starting character. Possibilities Include: Additional Freebies (50), 7th Generation Vampire, +Rank Starting Shifter, etc.
These stack!!! If you already have a Shifter and want to play another one at Rank 2 you have to have 200 points of Karma to do so.