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 their balance due to GSNNJ from either the Cookie Program or Fall Product Program 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:

Other
I am an authorized user for this Troop's checking account:
Type of Bank Account
Please enter your account information exactly as it appears on your check.

Do not include additional numbers.

Do not include a check number.

If you did not receive checks, please upload a photo of a bank statment or other document that clearly shows the account number.
Bank Name

Other
Routing Number
Account Number
Please upload a picture of a voided Troop Check
Signature
Should be Empty:

Troop Product Program Payment Authorization (ACH)