IRG (Juliette) Funds Usage Request Form

IRG Funds Usage Form

Juliette Proceeds
We are so excited that you are using your IRG/Juliette funds. Please select how you would like to use it and enter the amount to be applied or reimbursed. If you do not have a sufficient amount of funds in your account you will be contacted by a staff member to pay the balance due.

Need Balance Information ...

IRG Funds: please contact the Customer Engagement Team at 1.800.943.4414 or info@gsnypenn.org

· Some restrictions apply. All Girl Scout experience reimbursement/payment requests are subject to review and approval in accordance with GSNYPENN, GSUSA, and IRS regulations. GSNYPENN is unable to reimburse submissions for items outside these regulations and intended use.
Requester's Name*

First NameLast Name
Requester's Email*
example@example.com
Requester's Phone Number*

Area CodePhone Number
Girl Scout's Name

First NameLast Name
How would you like to use your IRG funds:*

MembershipCamp or ProgramReimbursement
Information for Membership*
Information for Camp or Program *
Make Check Payable To:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Receipts for Reimbursement*

Browse Files
Multiple files may be uploaded. Pictures, scans, PDFs, etc. Cancelof
Total to be reimbursed: Total Reimbursed:* .
Should be Empty:

IRG Funds Usage Form