ACH Authorization Form

ACH Authorization Form for Troop Bank Accounts
All troop bank accounts need a signed ACH Authorization Form on file with GSMW.

If we have a current ACH on file for your troop's bank account, it is not necessary to resubmit another ACH form unless you've made changes to your troop's bank account this year.

If there have been changes, a newly signed and dated ACH Authorization Form must be submitted to the GSMW Finance Department. These changes include adding or changing signers on an account.
Person Submitting Form*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Troop Number*
Troop Role*

Bank Account Information
Type of Account*

CheckingSavings
Bank Name*
Routing Number*
Bank Account Number*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I will be providing a voided check via:*

Uploading an image of the voided check belowMailing it to GSMW with a copy of this ACH form
Upload copy of voided check

Browse Files

Cancelof
If you choose to mail a voided check to GSMW, please attach it to a printed copy of this completed form (you will receive a confirmation email that you can print).

Mail voided check and copy of ACH form to:

GSMW
Attn: Accounting
2303 Grand Ave
Billings, MT 59102

Authorization

This authorization must be signed by one authorized check signer for the troop. The signer of this form takes responsibility in notifying the secondary Bank Account signer of the agreements listed below.
By checking the boxes below, I acknowledge that all Bank Account Signers agree to the following terms:*

I verify that the troop account is set up under the GSMW Council Tax ID NumberI understand that GSMW will debit the above troop bank account according to the instructions provided during Financial Literacy trainingI understand that troops are responsible for depositing sufficient funds to cover ACH debits from their troop account, and will be responsible for any resulting non-sufficient funds (NSF) charges. Council will reimburse troop for customer NSF charges only.I confirm that the Troop expressly authorizes GSMW to repeat debits that fail for any reason and may include return fees at the discretion of council.As a signer on the account, I understand that I must complete the Troop Annual Report and turn into council by June 30th each year.
Primary Signer (Person Completing Form)

This person is signing this form on behalf of the Troop and takes responsibility in notifying the secondary Bank Account signer of the agreements listed above.
Name*

First NameLast Name
Troop Role*
Secondary Signer

This person is not formally signing this authorization. By filling this form out as the primary signer, I agree that the secondary signer below has been or will be notified of the agreements listed above.
Name*

First NameLast Name
Troop Role*
Phone Number*

Area CodePhone Number
Email*
example@example.com

Additional Questions or Comments
Should be Empty:

ACH Authorization Form for Troop Bank Accounts

Bank Account Information

Authorization

Primary Signer (Person Completing Form)

Secondary Signer