Unpaid Balance Girl Shortage

Unpaid Balance Girl Shortage

Fill out and submit this form with the required supporting documents to ensure that all unpaid balances are reported during your End-of-Program Audit process. An adjustment to the troop's Balance Due will be made based on the information provided.
Five Digit Troop Number*
Girl Scout's Name*

First NameLast Name
Caregiver Responsible for Payment*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Number of Units/Packages Sold (Do Not include Booth Sales)*
(b) Total Due Overall*
(c) Total Caregiver Paid*
(d) Balance Due from Caregiver (b-c)*
Documentation Required

The following must be submitted with this form: * Signed 2024-2025 Product Program Parent Permission Form * Signed RECEIPTS when product was received by caregiver * Signed RECEIPTS for any money paid by caregiver * Any notes or comments from communication with caregiver regarding the unpaid balance
Attach: 2024-2025 Product Program Parent Permission Form*

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Attach: Signed Product Receipts*

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Attach: Signed Money Receipts*

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Attach: Additional Information you feel we should know

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Notes or comments from communication with responsible person regarding the unpaid balance (dates you talked, what was said, etc.)*
Name of person completing this form.*

First NameLast Name
Phone Number of person completing this form.*

Area CodePhone Number
Email of person completing this form.*
Please verify that you are human*
Should be Empty:

Documentation Required