Parent Past Due Cookie Account Form

Parent Past Due Cookie Account Form

Parent Past Due Girl Scout Cookie Account forms with signed receipts must be submitted no later than March 17, 2023. Incomplete forms and those with no receipts will not be accepted. Please use the document upload section of this form to upload receipts and other documentation you need to submit to council.
Troop Number (must be 5 digits)*
Service Unit Name*
Person Responsible for Payment*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment*
Girl Scout's Name*

First NameLast Name
Total Number of Packages Sold*
(a) Number of packages sold at $6*
(b) Total Due*
(c) Total Parent Paid*
(d) Balance due from Parent (b-c)*
Documentation
The following must be submitted with this form:
- Receipts signed when cookies checked out
- Receipts for any money paid by responsible party
- Documenation (dates) of communication with responsible person regarding account (examples: write up every date you talked, what was said, etc.)
Please upload all applicable documentation:*

Cancelof
Name of person completing this form*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Should be Empty:

Documentation