ACH Authorization

Troop Product Program Payment Authorization (ACH)

ACH=Automated Clearing House
Thank you for taking the time to complete this form.

By signing this form, you agree to allow Girl Scouts of Northern New Jersey (GSNNJ) to debit your Troop's checking account for thier balance due to GSNNJ from either the Cookie Program or Fall Product Porgram or to credit your Troop's checking account with Troop Proceeds or other money owed to the troop.

GSNNJ will post the payment schedule and FAQs on our website www.gsnnj.org
Troop Number (5 digit)*
Service Unit
Name*

First NameLast Name
Email*
example@example.com
My role in the troop is:*

Troop LeaderTroop Co-LeaderFall Product Program ManagerGirl Scout Cookie Program ManagerOther
I am an authorized user for this Troop's checking account:*

YesNo
Type of Bank Account*

Troop Checking Account
Please enter your account information exactly as it appears on your check.

Do not include additonal numbers.

Do not include a check number.

If you did not receive checks, please upload a photo of a note stating that.
Bank Name

Atlantic Stewardship BankBank of AmericaBank of NJBlue Foundry BankChase BankColumbia BankConnect OneFirst Hope BankFulton BankGlen Rock Savings BankKearny BankM&T BankNorth Jersey Credit UnionNVE BankOritani BankPeapack Gladstone BankPNC BankProvident BankSantanderSB BankTD BankValley National BankVisions Credit UnionWells FargoOther
Routing Number*
Account Number*
Please upload a picture of a voided Troop Check*
Signature*

Clear
Should be Empty:

Troop Product Program Payment Authorization (ACH)