CREDIT APPLICATION FORM

HARRIS-POP! HOTELS AND CONVENTIONS GUBENG - SURABAYA

COMPANYS DATA
Companys/Firms :

NPWP No.

Nature of Business :

Address :

Phone No :
Fax No. :

Type of Company :
Sole Proprietor
Joint Venture
Public Government

Public LTD
Private LTD
Other
COMPANYS BANK DATA

Banks name :

Banks address :

Account No. :

Do your company / firm presently has or previously had an account with another hotel in Malang,Jakarta, Bali, Surabaya,
Batam, Bandung or other province? If yes, please furnish the following particulars.

Hotels Name

Address

1.
2.
3.
4.
5.

The undersigned ( an authorized signature ) hereby request that a corporate account to be opened for the company. In
connection with above particulars, the undersigned is authorized to receive and exchange of credit information. The
company will be liable for all charges incurred at HARRIS-POP! HOTELS & CONVENTIONS GUBENG SURABAYA by
the company guests, unless otherwise instructed in writing. The company will be bound by the Terms and Conditions
contained overleap upon approval of this credit application.

Name

Position Held

ID Card No.

Signature

Accounting & Finance

Manager
Note : It is important to fill this form completely, insufficient information may result in unnecessary delay in processing
this credit application. All terms and conditions overleaf are deemed to be part of this application and have been read,
understood and accepted in total at the time of your application for credit facilities at HARRIS-POP! HOTELS &
CONVENTIONS GUBENG SURABAYA
HARRIS-POP! HOTELS & CONVENTIONS GUBENG SURABAYA
Jl. Bangka 8 18 Gubeng Surabaya 60281 Indonesia
Telp +62 31 501 1100 Fax +62 31 501 2225

Page 1

CREDIT FACILITIES TERM AND CONDITIONS

1. These terms and conditions are deemed to be part(s) of the application for credit facilities at
HARRIS - POP! HOTELS & CONVENTIONS GUBENG - SURABAYA.
2. Granting of credit facilities shall be the sole discretion of HARRIS - POP! HOTELS &
CONVENTIONS GUBENG SURABAYA.
3. All charge incurred by the company shall be billed to its business address and settlement of
outstanding shall be payable within 14 days or 30 days upon presentation of the statement of
account.
4. The hotels reserve the right to charge an interest of 2% per month on overdue bills (i.e. exceeding
30 days and the company agrees to pay any such added charges.
5. The company must inform HARRIS - POP! HOTELS AND CONVENTIONS GUBENG SURABAYA
if there any changes/ amendments to the authorized signatures or any other related matters. This
must be in writing notifying the Hotel of the facts. Prior to the receipt of written notification the
company will be liable for any changes incurred thereafter.
6. Only these authorized persons stated overleaf shall make arrangements for accommodation, food
and beverage consumption, etc. in HARRIS - POP! HOTELS & CONVENTIONS GUBENG
SURABAYA. All instructions shall make in writing notifying. Any verbal communication regarding the
above must be followed by written confirmation.
7. Should the given credit limit be exceeded the difference is payable by company upon check out.
8. The credit facilitiesto of the company shall be reviewed periodically and the hotel reserves the right
to withdraw, suspend or increase the credit facilities at any time. Such notification shall be made in
writing to the company informing them of the hotels decision, without having to assign any reason
whatsoever.
9. The company undertakes to reimburse and to indemnity the hotel for all losses expenses and
damages suffered by the hotel in respect of non-payment of outstanding in so far as such losses
expenses and damages have resulted directly or indirectly from the negligence and/or malicious
action of the company and/or his guests.
10. HARRIS - POP! HOTELS AND CONVENTIONS GUBENG - SURABAYA does not accept
responsibility for the payment of the bank charges or fees resulting in transfer of money from your
account to our bank. Any such fees are the responsibility of your company and can not be deducted
from payments. Our bank and account number are as follows :

Bank Account ( IDR )

Bank Account ( USD )

Bank Name

Bank Name

Account Name

Account Name

Account Number

Account Number
Swift Code

HARRIS-POP! HOTELS & CONVENTIONS GUBENG SURABAYA

Jl. Bangka 8 18 Gubeng Surabaya 60281 Indonesia
Telp +62 31 501 1100 Fax +62 31 501 2225

Page 2

Please provide bellow information for accounting purpose

Accounting & Finance Departement Personel Detail

Accounting & Finance Manager
Name
Phone
Fax
Email
Account Payable
Name
Phone
Fax
Email

HARRIS-POP! HOTELS & CONVENTIONS GUBENG SURABAYA

Jl. Bangka 8 18 Gubeng Surabaya 60281 Indonesia
Telp +62 31 501 1100 Fax +62 31 501 2225

Page 3

Thank you for returning the filled-in credit application form by FAX and MAIL to our Account Receivable Spv.

FOR OFFICE USE ONLY

RECOMMENDED BY

POSITION

REMARK (IF ANY)

Credit Limit (local currency) :
GENERAL MANAGER

APPROVED/DISAPPROVED

FINANCIAL
CONTROLLER

APPROVED/DISAPPROVED

DIRECTOR OF SALES

APPROVED/DISAPPROVED

ACCOUNT RECEIVABLE
SPV.

APPROVED/DISAPPROVED

CUSTOMER CODE

HARRIS-POP! HOTELS & CONVENTIONS GUBENG SURABAYA

Jl. Bangka 8 18 Gubeng Surabaya 60281 Indonesia
Telp +62 31 501 1100 Fax +62 31 501 2225

ACCOUNT CODE

Page 4