.Direct Bill Application

REQUEST FOR CREDIT

Firm Name:
Billing Address:
Main Office Address:
Email:
Phone Number:
Attention:
Nature of Business:
BANK REFERENCE 1:
Name
Branch
Phone
Account Number
Bank Officer
BANK REFERENCE 2:
Name
Branch
Phone
Account Number
Bank Officer
HOTEL REFERENCE 1:
Name
Date of Meeting
Phone:
City/State
HOTEL REFERENCE 2:
Name
Date of Meeting
Phone:
City/State
HOTEL REFERENCE 3:
Name
Date of Meeting
Phone:
City/State

PERSONS AUTHORIZED TO SIGN FOR CHARGES TO BE BILLED:

Name 1
Name 2
PLEASE CHECK & INITIAL CHARGES TO BE BILLED:
Rooms & Tax
Valet
Food
Beverage
Phone
Banquet
Other:  
PURCHASE ORDER REQUIRED:
Yes       No
P.O. Number:
APPROXIMATE AMOUNT TO BE BILLED:
Rooms & Tax
Banquet
F&B
Other
Arrival Date
Departure Date
Sales Manager
The undersigned agrees to make immediate payment upon receipt of statement. In the event payment is not made within 25 days after receipt of the original statement, it is agreed that the hotel may impose a LATE PAYMENT CHARGE at the rate of 1½% per month (ANNUAL RATE 18%), or the maximum allowed by law, on the unpaid balance and the reasonable cost of collection, including attorney fees:
Authorized Signature 1
Signature (Please type name)   Title   Date  
Authorized Signature 2
Signature (Please type name)   Title   Date  

NOTE: Credit cannot be authorized without this request on file. This should be received by our office no later than two (2) weeks prior to your planned arrival.