Regular Membership Application

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Company Registration Name

Trading As

Company Registration No

VAT Registration No

Main Contact (For Repak Communications)

Title/Position

Telephone

Mobile

CEO, if different from Main Contact

Financial Contact, if different from Main Contact

Statistical Contact (Person with responsibility for Packaging Statistics Returns twice yearly)

Do you have multiple premises?
YesNo

If YES, please specify how many (not including primary address above) and provide details with full postal address below.

Premise Name

Bank Details
Repak operates a fee rebate programme to compliant members, subject to certain terms and conditions. Rebates, where applicable, are paid directly to the member’s bank account. If you wish to avail of the fee rebate programme, your bank details will be required for transfer payment. Note: you may also enter this details online on becoming a Repak member.

Bank Name

Bank Account Name

IBAN

BIC

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