Ach Electronic Debit Authorization Form - 2015-2016 printable pdf download

ACH Electronic Debit/Credit Authorization

2015‐2016

This form is to be used by GSSI Troops to authorize ACH debit/credit transactions and is to be completed and signed

yearly the during Service Unit (SU) program trainings.

Troop Acknowledges and Agrees to:

1. Troops must provide either a voided check or a copy of a check (verifying banking information) and the

completed/signed paperwork at the SU product training. The Troop is responsible for providing the above

information to Council for:

a. Nut Candy and Magazine Program no later than September 28, 2015

b. Cookie Program no later than January 15, 2016 (if you did not participate in the Nut, Candy & Magazine

Program)

2. Troops will verify the amount to be withdrawn based on the product recorded in the online systems (Nut‐E,

eBudde) for each sale prior to the deadlines. If an adjustment needs to be made due to a parent’s outstanding

balance or other circumstances, Troops must submit the appropriate Adjustment Request Form no later than

three business days before GSSI debits the account if the payment amount needs to be reduced.

3. The Troop is responsible for turning in a Product Program Collection Form for any parent that is delinquent in

order to reduce the amount of money that is debited from the Troop’s account for final payment.

4. The Troop is responsible for depositing sufficient funds to cover this debit and will be responsible for any

resulting non‐sufficient (NSF) charges. Please allow at least three business days for deposited checks to clear.

5. The Troop expressly authorizes GSSI to repeat any debit that fails for any reason.

6. The Troop agrees to work closely with GSSI to pay all amounts due to Council in any manner agreed to by both

parties.

7. This authority will remain in full force and effect until GSSI has received written notification of its termination in

such a time and manner as to afford GSSI and the Depository a reasonable opportunity to act upon it.

This authorization must be signed by an authorized check signer for the Troop #_________________ SU # ________

Signature________________________________________________

Date___________________________________

Printed Name____________________________________________

Position________________________________

Address___________________________________________________________________________________________

City___________________________________________________, IL

Zip Code_______________________________

Email__________________________________________________

Telephone______________________________

Routing Number _________________________________ Account Number ___________________________________

Staple voided or copy of Troop check. (Do not provide a deposit slip)

If a voided check or check copy is not available, the bank must provide the bank routing and Troop account number on

bank letterhead.

Ach Electronic Debit Authorization Form - 2015-2016