Missouri Office of Administration



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State of Missouri – Enterprise Holdings (Enterprise Rent-A-Car and National Car Rental)

Procurement Card Billing Account Application

To establish an Enterprise Holdings, Inc. Billing Account

|Account Action Required | | Yes No |

|Create New Account: | |Update Existing | |I would like to receive |

| | |Account #: | |electronic receipts for |

|Yes |OR | | |transactions on my account. |

|State Agency Name:       |Today's Date:       |

| | |

|State Agency Number:      | |

| | |

|Department Name:       |Phone Number:       |

| | |

|Department Number:       | |

| Address:       |City :      |

| | |

| |State:       Zip Code:       |

|Last four digits of the procurement card to be used for rental charges |Expiration Date:       |

|(You will be contacted by EHI’s Credit Department for the remaining card info.):       | |

|Name as it appears on Card:       |Email Address:       |

| | |

|Signature Required Below: |

| |

| |

| |

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To submit, please scan and email to Ross.Deeken@ or print and fax to 877-255-5028.

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