Product Program Banking Authorization Form (Troop/SU ACH)
This form is required in order to begin each Product Program Season. By completing this form you agree to allow Girl Scouts of Historic Georgia to debit or credit the Troop bank account. Included will be a latest voided check or letter from the financial institution with full routing and bank account number on a letterhead.
Name
*
First Name
Last Name
Email
*
example@example.com
Who are you completing this form for?
*
Service Unit
Troop
Who are you completing this form for?
*
Service Unit
Troop
If completing for your Service Unit, please type 00000 in the Troop Number section.
Region
*
1-Athens/Gainesville
2-Augusta
3-Savannah
4-Albany
5-Columbus
6-Lizella/Macon
If unknown please select the closet office to you.
Service Unit
*
Unknown Service Unit
Not In a Troop - Individually Participating (IRM/IRG/Juliette)
Apalachee Falls Service Unit
Bryan County Service Unit
Burke Jenkins Service Unit
CDW Service Unit
Cherry Service Unit
Concharty Service Unit
Cotton Blossoms Service Unit
Cottonwood Service Unit
Effingham Service Unit
Emerald Rose Service Unit
Evergreen Service Unit
Flint Service Unit
Ft. Moore Service Unit
Golden Hills Service Unit
Good Life Service Unit
Greater Clarks Hill Service Unit
Harmony Grove Service Unit
Heart of Georgia Service Unit
Heritage Plains Service Unit
Jefferson/Glascock Service Unit
Juliette's Southern Rose Service Unit
Lake Oconee Service Unit
Little River Service Unit
Marshes of Glynn Service Unit
McDuffie/Warren/Wilkes Service Unit
Mimosa Service Unit
Muckalee Service Unit
Nochaway Service Unit
North Chatham Service Unit
Ocmulgee Service Unit
Richmond Service Unit
River Shoals Service Unit
Sinconee Service Unit
Sweet Onion Service Unit
Sycamore Service Unit
T.A.G.G.S Service Unit
The Falls Service Unit
The Lakes Service Unit
The Meadows Service Unit
The Mountains Service Unit
Washington/Johnson Service Unit
Watermelon Service Unit
Wild Daisy Service Unit
Wiregrass Service Unit
Wisteria Service Unit
Troop Number
*
(5 digits)
Which Product Program are you participating in ?
Fall Product Program
Cookie Program
I am participating in both Cookie Program and Fall Product Program.
Routing Number
*
must be 9 numbers - no spaces
Account Number
*
must be 5-12 numbers - no spaces
Bank Name
*
Bank Branch
*
City, State
Bank Phone Number
-
Area Code
Phone Number
Date
*
/
Month
/
Day
Year
Date
Upload your voided check or bank deposit letterhead
Browse Files
If you don't have voided checks, you can request an official document from your local branch.
Cancel
of
Signature of authorized signer on the account
*
Enter the message as it's shown
*
Submit
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