Sheet 1: Hyatt

	
	
	
	
	
	
	
	
	
	

		


		


		


		

 
		
		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		
LSU Health Direct Bill Authorization & Reservation Request Form
		
	

		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Hotel:                                 
		
Hyatt Regency New Orleans
		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Guest Name:
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Reservation Confirmation Number:
		


		
Hotel use only:
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Arrival Date & Number of Night(s):
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Account Billing Address:
		


		
433 Bolivar St. Attn: Accounts Payable
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
City/State/Zip:
		


		
New Orleans,  LA 70112
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Contact Phone #:
		


		


		
Contact Email Address:
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
I hereby authorize the following charges to be applied to the account. 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Check all that apply:
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Room & Tax
		


		


		
Parking
		


		


		
Internet/WiFi
		


		


		


		


	
	

		


		


		
Catered/Banquet Meals
		


		


		
Meeting Rooms
		


		


		
Other Meeting/Banquet Charges
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
I hereby authorize the following amount to be applied to the University account #             
		


		


		


		


		


		
 AR 138095
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Comments:
		


		
	

		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Purchase Order #
		


		


		


		
Department Name:
		


		


		


		


		


		


	
	

		
Department ID (valid dept id required)
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Date:
		


		


		


		
Department Contact Phone#
		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Signature:
		


		


		


		


		


		


		


		


		


		
Date:
		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
State
		
Federal
		
Local
		
City Occupancy
		


		


		


		


		


		


		


	
	

		
*Qualifies for tax exempt status 
		


		


		


		


		
N/A
		


		


		


		


		


		


		


	
	

		
* Tax exemption form required 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Please email this completed form to
		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
MSYRN-TA@hyatt.com
		
	

		
Please call our Corporate
		
	

		
Reservations Line for assistance:
		
	

		
504-613-3784
		
	

		
*Please transmit this form at least 24 hours prior to arrival in order to ensure your request is processed. Reservation, rate and room types are subject to availability at the time of booking
		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
By submitting this form and any supporting documents, I confirm that I have read and agreed to the use of the personal information
		
	

		
I am giving you in accordance with your Global Privacy Policy for Guests, which is available at privacy.hyatt.com
		



Sheet 2: Intercontinental

	
	
	
	
	
	
	
	
	
	

		


		


		


		

 
		
		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		


		


		


		


		


		


	
	

		
LSU Health Direct Bill Authorization & Reservation Request Form
		
	

		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Hotel:                                 
		
Intercontinental, New Orleans
		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Guest Name:
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Reservation Confirmation Number:
		


		
Hotel use only:
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Arrival Date & Number of Night(s):
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Account Billing Address:
		


		
433 Bolivar St. Attn: Accounts Payable
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
City/State/Zip:
		


		
New Orleans,  LA 70112
		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Contact Phone #:
		


		


		
Contact Email Address:
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
I hereby authorize the following charges to be applied to the account. 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Check all that apply:
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Room & Tax
		


		


		
Parking
		


		


		
Internet/WiFi
		


		


		


		


	
	

		


		


		
Catered/Banquet Meals
		


		


		
Meeting Rooms
		


		


		
Other Meeting/Banquet Charges
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
I hereby authorize the following amount to be applied to the University account #             
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Comments:
		


		
	

		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Purchase Order #
		


		


		


		
Department Name:
		


		


		


		


		


		


	
	

		
Department ID (valid dept id required)
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Date:
		


		


		


		
Department Contact Phone#
		


		


		


		


		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Signature:
		


		


		


		


		


		


		


		


		


		
Date:
		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
State
		
Federal
		
Local
		
City Occupancy
		


		


		


		


		


		


		


	
	

		
*Qualifies for tax exempt status 
		


		


		


		


		
N/A
		


		


		


		


		


		


		


	
	

		
* Tax exemption form required 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
Please email this completed form to
		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		
olga.andronachi@icneworleans.com
		
	

		
Please call our Corporate
		
	

		
Reservations Line for assistance:
		
	

		
504-585-4309
		
	

		
*Please transmit this form at least 24 hours prior to arrival in order to ensure your request is processed. Reservation, rate and room types are subject to availability at the time of booking