CREDIT APPLICATION FORM

Holiday Inn Express Jakarta Matraman

1. Company Details

Name in full : ..........................................................................................................................

Address : ......................................................... Company
......................................................... Sole Proprietorship / Partnership
......................................................... Other..................................................
Tel. :......................................................... Fax..........................................................
Email : ..........................................................................................................................
Nature of Business:......................................................................................................................
Date of Incorporation: ................................................ Business Registration No: .....................

*** Copy of Company registration certification to be attached ***

2. Bank Reference

Name, Branch : ..........................................................................................................................

Address : ..........................................................................................................................
Country : ........................................................... Tel: ..................................................
Account Number: ........................................................ Since: ..............................................

3. Hotel References

(1) Name, Location : ............................................................................................................

Trading period : ............................................................................................................
(2) Name, Location : ............................................................................................................
Trading period : ............................................................................................................
(3) Name, Location : ............................................................................................................
Trading period : ............................................................................................................

4. Credit Card References

(1) ...................... ................ ....................... ................... ......................

(Credit Card) (Issued to) (Account No.) (Expired) (Credit Limit)

(2) ...................... ................ ....................... ................... ......................

(Credit Card) (Issued to) (Account No.) (Expired) (Credit Limit)

5. Authorized Personnel

(1) Name: ................................................... (2) Name: ...................................................

Signature: ............................................. Signature: .............................................
Designation: ......................................... Designation: .........................................
NRIC / Passport No: ............................ NRIC / Passport No: ............................

6. Billing Instruction

All Hotel Charges

Room / Tax / Services Only

7. Accounting / Finance

Contact Person : .........................................................................................................................

Email : .........................................................................................................................
Telephone : .........................................................................................................................

8. Credit Limit Requested: IDR................................................................

* Incomplete applications may be delayed in processing or rejected -

I/We confirm that all information given in making this application is true, correct and
complete, and hereby authorize the hotel on verify the information with any source the Hotel
may consider appropriate.
I/We acknowledge that any approved credit facility can only be used subject to the terms and
conditions contained herein and I/We agree to be bound by the terms and conditions upon my
application being approved.

Name : .......................................................

Tittle : ....................................................... ........................................................................

Signature, Date and Stamp

TERMS & CONDITIONS

1. The Granting of credit facility will be entirely at the direction of the Hotel and no reasons
may be given for rejection of any application.
2. The approved credit facility is not transferable.
3. All charges incurred are payable to the Hotel on presentation of invoice. The company
agrees to pay interest at the rate of 1% per month for all outstanding bills and charges
beyond the said period.
4. Legal proceeding may be instituted for failure to settle outstanding invoices, inclusive all
cost of collection, legal fees and litigation expenses.
5. The proprietor / partners / directors of the Company agree to assume liability jointly and
severally for all debts and charges incurred by the Company.
6. The Hotel reserves the right to review and/or cancel any credit facility form time to time
as its absolute discretion.

HOLIDAY INN EXPRESS JAKARTA MATRAMAN

HOTEL INTERNAL USE ONLY

Director of Sales Manager Signature: .................................................... Date: ..........................

Chief Accounting Signature: .................................................................. Date: ..........................

Hotel Manager Signature: ....................................................................... Date: ..........................

Full Payment Required : Yes No

Deposit Required : IDR..............................................

Approval Credit Limit : IDR............................................... TERMS: .................. DAYS