2022 COOKIE DOUGH REDEMPTION FORM

2022 COOKIE DOUGH REDEMPTION FORM
This form should be used to have a check sent to a Troop Leader or Service Unit Manager so that the Girl Scout can use some or all the Cookie Dough she earned in the 2021 Cookie Program. The check can only be made payable and sent to the troop leader and/or service unit manager.

Both the Girl Scout and her parent/guardian must sign the form. The Cookie Dough number and the purpose for which it will be used are required (i.e. troop activity, registration, uniform).

Forms which are not fully completed cannot be processed and in such a case the parent/guardian will be notified by phone or email.

Expiration Date: May 31, 2023

If you have any questions or need additional information, please email us at productsales@girlscoutsneny.org.
Girl Scout's Printed Name*
Troop #*
Community (Service Unit) #
Parent/Guardian Printed Name*
Contact #*
I wish for all of my current balance of my Cookie Dough to be sent to my troop leader or Serice Unit*

Yes
It will be used for the following Girl Scout item(s) and/or activities*
Troop/SU Leader Mailing Full Name*
Troop/SU Leader Email Address*
Mailing Address
City
State
Zip Code
Girl Scout Signature

Clear
Parent/Guardian Signature

Clear
Should be Empty: