Outstanding Balance Report Form

Outstanding Balance Details - Troop
Financial Literacy Program *

Fall Program Cookie Program
Amount Paid to Date *
Remaining Balance Due to Council *
Outstanding $$ *
Confirmation of remaining balance due
Comments (late money reason, unsold box count, plans for selling, etc.) *
PLEASE NOTE: The bank account signers of this troop will take full responsibility for the outstanding funds of this troop.

Please be aware that this may impact the ability for account signers to handle troop funds in the future and therefore signers may also be removed from accessing the troop bank account.
Acknowledgement *

The financial liability of the above information is the responsibility of the troop. I understand that any remaining outstanding funds for the troop may impact the ability of account signers to handle troop funds in the future and may impact how the troop participates in product programs.
Signed *
Example: Susie Q. Sample
Date *

Month Day Year
Date
It is preferred that you provide GSMW signed receipts of product received.

If you have trouble uploading them below, please note this in the Additional Comments at the end of this form and email them to customercare@gsmw.org.
Upload Receipts

Cancel of

Outstanding Balance - Family Information
Acknowledgement *

The financial liability of the troop is released of this outstanding balance once council has confirmed the completed information has been received.
Girl Name *

First Name Last Name
Adult Responsible for Balance *

First Name Last Name
Adult Responsible Email *
example@example.com
Adult Responsible Phone Number *

Area Code Phone Number
Adult Responsible Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Collection Attempts

Documentation of three collection attempts is expected by the Troop Leader and/or Service Unit Manager BEFORE submitting this form to GSMW. Please document those attempts below.

Record of Attempts *

Person Submitting Form