Troop Debt Form - Girl Scout Cookie Program - 2016 printable pdf download

TROOP DEBT FORM

2016 GIRL SCOUT COOKIE PROGRAM

This form is used to notify GSCP2P of unavailable troop funds to cover an ACH withdrawal.

This form must be completed to suspend or adjust the amount of a troop’s ACH withdrawal for the cookie program. A separate

request is required for each withdrawal. GSCP2P cannot honor requests/forms received after the deadlines below!

The first withdrawal (on February 10) will be 50% of the troop’s initial order. The second withdrawal (on February 24) will be for

the remaining 50% of the troop’s initial order. The third withdrawal (on March 28) will be the full remaining balance owed by the

troop.

There is a fee that will be charged to defer an ACH withdrawal and/or for ACH rejections. Troops will be charged 2% of any

amount deferred (or $20 minimum) and/or 2% of any amount rejected (or $35 minimum). This fee will be added to your

final ACH withdrawal on March 28.

Deadlines (Received/In Council Hands)

For February 10 ACH Withdrawal – February 8

For February 24 ACH Withdrawal – February 22

For March 28 ACH Withdrawal – March 23

Troop Information

Troop Number ______________

Service Unit ________________________________________

Date __________________________

Form Completed By ___________________________________________________ Phone #’s____________________________________

Mailing Address _____________________________________________________________________________________________

Street Address ______________________________________________________________________________________________

E-mail Address ______________________________________________________________________________________________

ACH Information

Amount Due Council $ ______________

Scheduled Date of ACH Withdrawal ____________________________

Amount Available for Withdrawal from Troop Account $ ______________

Estimated Date Remaining Balance Due Will Be Available:_____________________________

Essential Information

Reason Funds Are Unavailable: _______________________________________________________________________________________

____________________________________________________________________________________________________________________

Actions Taken to Date: ______________________________________________________________________________________________

_____________________________________________________________________________________________________________

Comments

_____________________________________________________________________________________________________________

* Deferral and rejection fees will not be included in your ACH email notification.

I understand that in the event any of my ACH withdrawals are adjusted, suspended or rejected, the amount due will

be added to the final ACH withdrawal on March 28. I also understand that this will be 100% of what is owed, plus any

fees, less any previous collections that have been posted.

I also understand that there are three scheduled ACH withdrawals for the 2016 cookie sale. Balances remaining after

the third withdrawal may be collected via additional ACH withdrawals as necessary.

Signature: ____________________________________________________________ Date: _________________________

RETURN FORM TO: FINANCE DEPT., GSCP2P, 8818 W. MARKET ST., COLFAX, NC 27235

Fax – 336-369-7476

Troop Debt Form - Girl Scout Cookie Program - 2016