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Individual Collection (IC) Form Product Program
Submit this form to report girls who are not paid in full. Troops should never pay for a girls delinquency.
NOTE: Forms submitted after the due date WILL NOT be accepted and WILL BE the troop's responsibility.
Please select which Product Program this IC form is for:
*
Fall Product Program
Cookie Program
FALL PRODUCT PROGRAM
DUE BY: Octobr 27, 2022
COOKIE PROGRAM
DUE BY: March 15, 2023
TROOP INFORMATION
Service Unit #
*
Five-Digit Troop #
*
Troop Product Manager First Name
*
Troop Product Manager Last Name
*
Home Phone Number
with Area Code
*
Cell Phone Number
with Area Code
*
Troop Product Manager Email
*
Confirm Email
*
Is the Troop Product Manager the SAME person as the Troop Leader?
*
Yes
No
Troop Leader First Name
Troop Leader Last Name
Troop Leader Home Phone
with Area Code
Troop Leader Cell Phone
with Area Code
Troop Leader Email
Confirm Email
GIRL SCOUT INFORMATION
Girl Scouts First Name
*
Girl Scouts Last Name
*
Girl Scouts Address
*
Girl Scouts City
*
Girl Scouts State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Girl Scouts Zip
*
PARENT/GUARDIAN INFORMATION
Mother's First Name
*
Mother's Last Name
*
Mother's Phone # w/area code
*
Parent Email
*
Confirm Email
*
Father's First Name
Father's Last Name
Father's Phone # w/area code
Guardian First Name
Guardian Last Name
Guardian Phone # w/area code
FINANCIAL INFORMATION
Girls Total Sales Amount $
*
Girls Total Amount Paid $
*
Girls Total Amount Due $
*
ATTEMPS TO COLLECT
Please list in complete detail all collection attempts made to the parent/guardian.
Date Contacted:
*
Who you spoke to:
*
Contact Results :
*
Date Contacted:
*
Who you spoke to:
*
Contact Results:
*
Date Contacted:
*
Who you spoke to:
*
Contact Results:
*