Become a Provider

First Name *

Name of Organisation *

Name of Fundraiser *

Last Name *

Address *

Manager of Organisation *

Manager of Fundraiser *

Phone Number *

Phone Number *

Your Digital Store Name Eg. (Brian | Personal trainer | Dublin) Max 40 characters *

Registered Charity Number (RCN) *

Tax Reference Number (TRN) *

Business URL Eg. brianspersonaltrainingdublin (No spaces between words please) *

Biographical Info *

Your Fundraiser Page Name (Eg. Fundraiser Name-Dublin) Max 40 characters *

Biographical Info *

Fundraiser URL Eg. This is the piece that follows after Flexitime.ie (No spaces between words please) *

Profile Picture  *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx

Your Organisations Page Name Eg. (Organisation Name-Dublin) Max 40 characters *

Organisation URL Eg. This is the piece that follows after Flexitime.ie (No spaces between words please) *

Bio Picture *
Supported file types: jpg, jpeg, png, txt, pdf, doc, docx