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


Premises 1 information

*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


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


Repak ELT will issue invoices 30 days in advance of requesting payment from your bank.

Retail only members will have a single annual payment due for registration. Importers will have quarterly payments due.

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