Your Hotel Name
Your Hotel Address
Your Hotel Phone: () -
Direct Billing Request/Application
In order to establish a Direct Bill Account, please complete the following form and return it to our Hotel by email to or faxing to (XXX) xxx-xxxx. All invoices must be paid within (30) thirty days upon receipt of bill, unless other arrangements have been made.
Name of Business/Organization requesting credit: ______
Other business names used to establish credit:______
Billing Address: ______
Previous Address: ______
Other Addresses used for credit:______
Does your address change with officer: YESNO
Contact Person:Title:______
Phone #:______Fax #:______
Credit Limit Requested: Room Rate:
Credit Card on File: YES / NO (#0123-4567-8910-1112)
Names of all who are authorized to charge on this account:
Charges to Master Account (Please mark all that apply)
Room/Tax Only All Charges Movies:
Long Distance Laundry Service Other:
Reference Section
Please list at least (3) three current Hotel/Vendor References (hotels are preferred):
1.Name of Hotel/Company:
Address:
Phone #: Fax #:
Date ofEvent/Function:
Event/Function Name:
Contact Name:
2.Name of Hotel/Company:
Address:
Phone #: Fax #:
Date ofEvent/Function:
Event/Function Name:
Contact Name:
3.Name of Hotel/Company:
Address:
Phone #: Fax #:
Date ofEvent/Function:
Event/Function Name:
Contact Name:
4.Name of Hotel/Company:
Address:
Phone #: Fax #:
Date ofEvent/Function:
Event/Function Name:
Contact Name:
5.Name of Hotel/Company:
Address:
Phone #: Fax #:
Date ofEvent/Function:
Event/Function Name:
Contact Name:
As an authorized agent of your company, your signature below will provide acknowledgement that your company will pay the invoice upon receipt.
I (we) hereby authorize and direct that an investigation be made of these credit references. I agree to hold the hotel and their affiliates harmless from any action arising out of the legitimate and proper conduct of these investigations. I (we) agree that the above named company, firm, group, individual or organization shall pay the amount(s) due no later than thirty (30) days following the invoice date. Accounts not paid within thirty (30) days are subject to late charges. I (we) further personally guarantee, unconditionally and irrevocably, the payment upon demand of all liabilities and obligations, to include all costs incurred in connection with the enforcement of this guaranty.
______
SignatureDate
Print Name & Title
Office Use Only
Opening Date: Approved by:
Approval Amount: Rate Honored: