Set up your Direct Debit

Complete the form below to authorise us to collect payments from your bank account

Account Holder's Full Name*

First Name

Account Holder's Full Name*

Last Name

Company Name (if applicable)

Optional

What Type Of Fuel Do You Have?*

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number

IBAN (Irish Bank Account Number)*

Bank Name*

Billing Address*

Street Address

Street Address Line 2 (Optional)

City

County

Eircode

Recurrent payment*

By ticking the box below, you authorise (A) Flogas Natural Gas Limited to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instruction from Flogas Natural Gas Limited. 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. Your rights are explained in a statement that you can obtain from your bank. *

I authorise Flogas to debit my account as per the provided details.