ACH Adjustment Request Form

Please select one *

Fall Product Program: Form due by October 23, 2024- Sweep date: October 25, 2024

Cookie Program: Form due by February 12, 2025 - Sweep 1 date: February 14, 2025

Cookie Program: Form due by March 12, 2025- sweep 2 date March 14, 2025

Complete this form if your troop cannot meet its financial obligation on the scheduled sweep date. Troop must pay 25% of balance due for the form to be accepted. Forms received after the due date will not be accepted.

PLEASE NOTE! An ACH adjustment submitted for the final fall product or cookie sweep will delay final sweep for 2 weeks only. Please contact Sheri Lambert at slambert@girlscoutsgcnwi.org with questions.

Today's date * +

Five Digit Troop # (i.e.12345) *

Service Unit # (i.e. 123) *

Troop Product Manger First Name *

Troop Product Manger Last Name *

Troop Leader First Name *

Troop Leader Last Name *

Balance currently due council: *

Available fund for this sweep: *

Do not sweep – amount not available: *

Reason funds are not available: *

Parent debt: If you have been unsuccessful collecting from a parent, complete and submit an Individual Collection (IC) Form. Do not pay a girl’s debt from troop proceeds. Do not give product to girls who have an outstanding balance. If you decide to pay a girl’s debt from troop proceeds or personal funds, you cannot be reimbursed at any point.

Other: Please explain Other: Please explain

Signature (please type your name) *

Your Position *

Your Phone number *

Your Email address *

Please confirm email address *

This form must be completed by a Troop Leader, Troop Product Manager, Troop Treasurer, or Service Unit Manager.

Requests received after the due date cannot be processed in time to avoid ACH troop account sweep and fees that might occur.