Shareholder Registration Form

How would you like to pay? - Pay Online & Complete Your Registration*

Paypal

How would you like to pay? - Post your payment & Complete your registration.*

Cheque / Postal OrderCash

Please select the number of shareholders you wish to pay for

Each Shareholding€2.50

Quantity

Total €0.00

Pay by Cheque / Postal Order

Please make cheques / Postal Orders payable to "Acorn to Oak Communications Plc" and post your payment to Attack The Tax, Kylekiproe Business Park, Portlaoise, Co. Laois.  Please also include the Unique ID (shown on the next screen once you click register), so we can allocate your payment. Please send €2 (offline) per share for each man/woman.

Pay by Cash

Please avoid sending coins if possible and post your payment to Attack The Tax, Kylekiproe Business Park, Portlaoise, Co. Laois.  Please also include the Unique ID (shown on the next screen once you click register), so we can allocate your payment. Please send €2 (offline) per share for each man/woman.

Name*

First NameLast Name

Address*

Street Address / Townland

Street Address Line 2

City / Town / VillageCounty / State / Province

Post/ Zip Code - Enter NA if Not ApplicableCountry

E-mail*

Phone Number

Area CodePhone Number

Are you 18+ years old?*

YesNo

Are you a homeowner?*

YesNo

Are you eligible to vote?*

YesNo

Did you register for the Household Charge or Property Tax?*

YesNo

Have you paid the Household Charge or Property Tax?*

YesNo

How did you hear about us? Single answer only*

Shareholder Registration

1st Shareholder Details

2nd Shareholder Details