Online Program Credit Request Form
Please complete this form if you would like to submit Program Credits to be transferred to a code used for making merchandise purchases in the Girl Scouts Online Shop. Please note that this code cannot be used toward purchases in-person at Girl Scouts River Valleys Shops and cannot be used for camp, event or membership purchases. The current processing time in which you will receive your code is two weeks.
Parent/Guardian Name
*
First Name
Last Name
Girl Name
*
First Name
Last Name
Email
*
example@example.com
Troop Number (Optional)
Enter the troop number or "Juliette"
Phone Number
*
-
Area Code
Phone Number
Amount of credits to be transferred to an online code:
*
Only use increments of $5. (Examples: 5, 15, 20, 100 etc.)
Type of Program Credit you are submitting:
*
Electronic Cookie Credits, Fall FUNds, or Juliette Program Credits
Cookie Credits
Fall FUNds
Please enter the first digit and the last 4 digits of the 19-digit Account Number
Please select which year the program credits you want transferred were issued? (Not required for Electronic Cookie Credits, Fall FUNds, or Juliette Program Credits)
*
-- Select One --
2019
2020
Both 2019 and 2020
You can transfer both 2019 and 2020 cookie credits to online codes at the same time. You will receive a different code for each year.
I understand I will not receive a code until my Program Credits are received by Girl Scouts River Valleys, and once credits are transferred to a code, the action cannot be undone.
*
Yes, I accept these terms.
Submit
Should be Empty: