COOKIE DOUGH REDEMPTION FORM
Girl Scout Juniors, Cadettes, Seniors, and Ambassadors can bank (save) Cookie Dough for approved Girl Scout
activities. Each girl must submit this form to the council headquarters to initiate the transfer of funds into the troop bank
account or to another Girl Scout council. Checks are mailed and/or automatic transfers are made on the 15th and/or
30th of each month.
Date _______________________
Girl’s name ____________________________________________________________________ Troop #____________________
Phone ______________________________________________________ Email ________________________________________
Leader’s name ______________________________________________ Phone _______________________________________
Email _______________________________________________________
AMOUNT OF COOKIE DOUGH REQUESTED $________________
FUNDS REQUESTED FOR:
Troop Travel (100+ miles) - Location:_____________________________
Date: From ____________ To ____________
destination: destination name __________________________________
Date: From ____________ To ____________
GSGCF Camp: Name of Session _______________________________
Date: From ____________ To ____________
Other Girl Scout Camp Location: _______________________________
Send monies to: ________________________
Council or service unit sponsored program:
Name of Program ______________________________________________ Date: From ____________ To ____________
Girl Scout Bronze, Silver or Gold Award expenses (please attach all receipts)
GSUSA Lifetime Membership
GSUSA Annual Membership
Girl signature ___________________________________ Parent/Guardian signature __________________________________
FOR OFFICE USE ONLY:
Approved to apply by director: Initials _______ Date _____/_____/__________
Cookie Dough verified ______________
Disbursement completed: Initials _______ Date _____/_____/__________
Amount available $________________
Cookie Dough applied on spreadsheet: Initials _______ Date _____/_____/__________
4780 Cattlemen Road • Sarasota, Florida 34233
941-921-5358 | 800-232-4475 |
C:Shelf Forms/2015 Forms/Cookie Dough Redemption Form ~ 6/15