greencom

good call - every call

Charities - Join Now

Section 1 - Choose your option

Donate the Difference

  OR

Share the Difference

  OR

Support

Section 2 - Charity Details

Your Chosen Charity is : Leprosy Mission International Leprosy Mission International

Section 3 - Personal Details

Title
Firstname
Surname
Address1
Address 2
Address 3
County / Area Code (inc Dublin area codes)

Section 4 - Line and Account Details

If you don't have your Account Number to hand, don't worry, please complete the phone number detail and the remainder of the this form. Our customer service team can contact you at a suitable time to get the remaining detail.

Account Number
Telephone Number
Second Telephone Number
Third Telephone Number

If you don't have your account number, please fill in the boxes below.

You can contact me any Between and
 
Area Code
 Phone Number
Daytime Number
Evening Number
Mobile Number
Email Address

Section 5 - Authorisation

You must check each of the boxes below to begin service with Greencom.

I authorise Greencom to active the above account numbers on my behalf.

I am over 18
I am authorised to act on behalf of the household in this matter.

I agree to to Greencom's Terms and Conditions of Service (Click here to view the T's & C's)

Section 6 - Notifications

I would like my details passed to my charity

I would like my charity to keep me updated with news and futher information.