DIRECT BILL APPLICATION In order to expedite processing, please complete ALL information below. Upon approval, full payment is due within 30 days of invoicing. Organization Name: Billing Address: City/ State/ Zip: Telephone: Contact: Company Controller: Email: MASTER ACCOUNT Please check which charges are to be billed to the master account: Suite/ Tax Incidentals Meeting/ Catering Misc. Please Specify Estimated Charges Please list individuals that are authorized to charge to the master account: ______________________________________________________________________________ ______________________________________________________________________________ CREDIT REFERENCES (H otels are preferred) Name: _________________ Name: __________________ Address: _________________ Address: __________________ City/State/Zip: _________________ City/ State/Zip: __________________ Dates: _________________ Dates: __________________ Telephone: _________________ Telephone: __________________ BANK REFERENCES Name: _________________ Name: _________________ Bank Contact: _________________ Bank Contact: _________________ Account Number: _________________ Account Number: _________________ Telephone: _________________ Telephone: _________________ Office Use Only Submitted By: ________________ Date: _________________ Approved By: ________________ Date: _________________ High Balance: ______________ __ Terms: _ _ _______________