Simple Steps for joining Repak ELT

Application

Membership Application Form

    1 Company Name and Address

    Company Registered Name

    Trading As

    Company Address 1

    Company Address 2

    Company Address 3 (optional)

    County

    Eircode (optional)

    Country


    2 Company Details

    Company Registration No

    Vat Registration No

    Telephone No

    Email Address

    Website Address (optional)

    Local Authority (Of head office)

    Total Number of premises


    2nd Premises if applicable

    *Only fill this section if your premise address differs from your main company address.

    Premises Name
    Premises Address 1
    Premises Address 2
    Premises Address 3
    Premises County
    Premises Eircode
    Premises Country
    Premises Phone
    Premises Contact Forename
    Premises Contact Surname
    Premises Local Authority


    3 Contact Information

    Main Contact Forename

    Main Contact Surname

    Main Contact Type

    Main Telephone No

    Main Email Address

    Main County

    Main Country *

    Accounts Contact Forename (optional)

    Accounts Contact Surname (optional)

    Accounts Telephone No

    Accounts Email Address

    Reporting Contact Information

    Reporting Contact Forename

    Reporting Contact Surname

    Reporting Contact Telephone No

    Reporting Contact Email Address


    4 Business type

    Please tick multiple boxes if appropriate
    ManufacturerATFImporter/WholesalerVehicle ImporterRetail OnlyCommercial Casings DealerWaste CollectorRe-TreaderWaste Facility (ELT)Tyre Equipment ProviderTyre Recycler
    Other (Please specify)


    5 Importing

    Do You Import Tyres? Please tick multiple boxes if appropriate
    yesno

    Other (Please specify)


    6 Direct Debit Mandate


    All Repak ELT members pay an annual registration fee. In addition producers will be invoiced monthly for tyres imported and reported to PRL.

    Direct Debit will be drawn down 30 days from date of invoice in accordance with payment terms.

    Invoices for membership will be issued with the fee collected from your bank 30 days after that.


    By signing this mandate form, you authorise (A) Repak ELT CLG to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Repak ELT CLG. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.

    Bank Name (optional)

    Bank Address 1 (optional)

    Bank Address 2 (optional)

    Bank Address 3 (optional)

    Bank Address 4(optional)

    Debtor's Account name (optional)

    Debtor’s Bank Identifier Code. - BIC

    Debtor’s Account No. - IBAN

    Creditor's Name (optional)

    Creditor's Identifier (optional)

    Creditor's Address (optional)

    City

    Eircode

    Type Of Payment
    Recurring Payment
    Signature (optional)

    Date Of Signature (optional)

    Note: Your rights regarding the above mandate are explained in a statement that you can obtain from your bank.

    I/we hereby make an application to register with Repak ELT and abide by Repak ELT Scheme Rules. I/we certify that the information given in this application is accurate and complete and can be authenticated if necessary

    The Waste Management (Tyres and Waste tyres) Regulations 2017 came into effect on October 1st. Are you ready to join?

    Join today