Greenstar Ltd., Millennium Business Park, Cappagh Road, Ballycoolin, FREEPOST F4493, Dublin 11.
T: Lo Call 1890 500 800. E:

  Name                                                                                               Surname


  Phone                                                           Mobile Number*                                                      E-mail Address

   *Please tick the box if you wish to receive text messages alerting you of your collection dates and Bank Holiday, Easter and C hristmas collection arrangements, as well as Special O ers.
   I hereby grant permission to Greenstar to pass notice of my cancellation to my current service provider (please tick).

I, the undersigned wish to apply for a Domestic Refuse and Recycling collection service from Greenstar Ltd.

Please tick the appropriate box for the yearly upfront payment of                                € 56.
     Cheque/Postal Order/Bank Draft (Please enclose payment of€ 56 with this application form)                                                                                           FOR OFFICE USE ONLY

     Credit Card             Card No                                                                                                        Exp Date                                     Account No.

     Laser Card              Card No                                                                                                        Exp Date
     By Direct Debit
Please tick this box if you would like to pay your quarterly charges by direct debit

Originator ID: 3 0 0 3 9 1

  1) The Manager, Bank
                               (full address of your Bank Branch)

  2) Name of Account holder                                                          Address
                                                                                     (if di erent from above)

  3) Sort Code                                                                       Account Number

   DATE:                                                                    SIGNATURE:

Please read carefully in relation to Direct Debit instruction: I instruct you (the bank) to pay Direct Debits from my account at the request of Greenstar Ltd. The amounts are variable and may be debited on
various dates. I understand that Greenstar Ltd may change the amounts and the dates only after giving me prior notice. I shall inform the Bank and Greenstar in writing if I wish to cancel this instruction.
I understand that if any direct Debit is paid which breaks the terms of the instruction, the bank will make a refund.
Banks may decline to accept instructions to pay Direct Debits from some types of accounts.
Important: The Wheelie Bins provided remain the property of Greenstar Ltd.
   Please tick here if you   DO NOTwish to receive information on other Greenstar products and services.        Please tick here if you      DOwish to receive information on other Greenstar products and services.

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