2023-2024 Automated Clearing House (ACH) Electronic Debit Authorization

Troop Volunteers acknowledge and agree to: *

I Agree

Troop authorizes GSNMT to debit the troop bank account for the total of the Council Proceeds ONLY minus any Outstanding Balance Reports that have been submitted on or before the due date.

Outstanding Balance Reports MUST be submitted online no later than the date stated in either the Fall Product Program or Cookie Program Troop Guide along with all receipts. Failure to submit Outstanding Balance Reports by the due date will result in the balance becoming the responsibility of the troop.

Troop is responsible for informing the GSNMT Product Program Department if bank account information has changed since the 2023 Girl Scout Cookie Program or any time during the 2023-2024 Girl Scout year. This includes providing either a voided troop check or letter or document from bank showing full bank account number and routing number for automated withdrawals or deposits.

I Agree

Troop authorizes GSNMT to debit the troop bank account for the total of the Council Proceeds ONLY minus any Outstanding Balance Reports that have been submitted on or before the due date.

Outstanding Balance Reports MUST be submitted online no later than the date stated in either the Fall Product Program or Cookie Program Troop Guide along with all receipts. Failure to submit Outstanding Balance Reports by the due date will result in the balance becoming the responsibility of the troop.

Troop is responsible for informing the GSNMT Product Program Department if bank account information has changed since the 2023 Girl Scout Cookie Program or any time during the 2023-2024 Girl Scout year. This includes providing either a voided troop check or letter or document from bank showing full bank account number and routing number for automated withdrawals or deposits.

Has your troop changed banks, had a bank name change, or opened a new troop bank account since the 2023 Girl Scout Cookie Program or since your troop's last product program withdrawal or deposit? *

No

Yes and I understand I need to submit proof to the GSNMT Product Program Department of bank account information.

Service Unit *

Troop Number *

Bank Name *

Last Four Digits of Troop Bank Account Number *

Full Legal Name *

Position in Troop *

Phone Number *

This authorization must be signed by an authorized bank account signer for the troop.

I am an authorized bank account signer and consider this my electronic signature with my name below. *

Today's Date *

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