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Troop Account ACH Debit/Credit Authorization

Authorized Troop Representative

First Name *

Middle Initial

Last Name *

Street Address *

City *

State *

Zip Code *

Primary Phone Number *

Primary Phone Type *

Day

Evening

Cell

Secondary Phone Number

Secondary Phone Type

Day

Evening

Cell

Email Address *

Confirm Email *

I am a: (select one) *

Troop Fall Product Sale Manager (TFM)

Troop Cookie Program Manager (TCM)

Troop Leader (TL)

Second Troop Authorized Check Signer

First Name *

Last Name *

Troop Information

Service Unit # *

5 Digit Troop # *

Troop Bank Information

Account Type: *

Checking

Savings

Name of Financial Institution *

Street Address *

City *

State *

Zip Code *

Routing Number (Verify your Routing Number is entered correctly) * 🛈

Account Number (Verify your Account Number is entered correctly) * 🛈

Check the box to see an example of a routing number and/or Account number

Upload an image of a voided check or letter from the bank, from this troop account. Scanned documents/images should be legible and include the troop number, account number and routing number.
If you are having difficulties uploading the image, please call the Product program help line 855-ILOVEGS X6722 🛈

Troop Agreement and Authorization

Troop agrees to and authorizes:

GSGCNWI will debit the troop bank account according to the instructions provided in the current Troop Fall Product Guide and Troop Cookie Program Guide.

Fall Product: 100% of order, less troop proceeds, will be debited on the date noted in the Fall Product Guide.
Cookie Program: 50% of initial order, less troop proceeds, will be debited on the date (ACH Sweep 1) noted in the Cookie Program Guide. The final balance due for all Council proceeds will be debited on the date (ACH Sweep 2) noted in the Cookie Program Guide.

Troops are responsible for depositing sufficient funds to cover these debits, and will be responsible for any resulting non-sufficient funds (NSF) charges.
Troop expressly authorizes GSGCNWI to repeat debits that fail for any reason.
Troop agrees to work closely with GSGCNWI to pay all amounts due to Council in any manner agreed to by both parties.
Troops understand that they may not participate in the Fall Product or Cookie Program until ACH Debit Authorization is received by the Council.
Troops MUST fill out a new ACH form for each product program sale every girl scout membership year.

By clicking the “ I AGREE” check box, you agree that you have read and understand the terms noted above. *

I Agree

Signature of Troop Leader (Type your name) *

Today's Date * +