GREENSTAR HOME SIGNUP FORM
Greenstar Ltd., Millennium Business Park, Cappagh Road, Ballycoolin, FREEPOST F4493, Dublin 11.
T: Lo Call 1890 500 800. E: firstname.lastname@example.org
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
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.