Parent Request for Cookie Dough Use

This form to be completed for requests to use Cookie Dough Rewards for extended troop/group travel, service unit events, partner events, or when a registrar asks for a Cookie Dough Reward card form to be submitted.

Form should be submitted at least 30 days prior to when payment is needed. Submitting this form does not guarantee registration for event. Contact event registrar separately for registration confirmation.

1. Service unit or volunteer organized events/camps - Submit Cookie Dough card information directly to registrar.

OR

2. Partner Events not sponsored by Girl Scouts of Western Washington.

• Due to IRS regulations, payments may only be made directly to vendors – caregivers cannot be reimbursed.

OR

3. Extended troop travel. Requirements for extended troop/group travel:

• Approved Intent for Extended Travel Application and/or Travel Application for Extended Trips or Travel Application for Destination Trips on file with Girl Scouts of Western Washington.

• Due to IRS regulations, payments may only be made directly to vendors – caregivers cannot be reimbursed. For troop travel, troops may request for Cookie Dough to be deposited into the troop bank account.

• Covered costs include: Commercial or public modes of transportation, Lodging, Program fees, such as GSUSA events, World Centers, GSWW or other Girl Scout council events and travel packages.

•Attach copies of any invoices, bills, confirmations, etc. from the commercial or public modes of transportation, lodging or program provider to this request form. These must include the cost per person or a breakdown of the costs therein.Please note that if not all required paperwork is received with the request form, it may delay payment to vendor.

4. For other uses or questions, please contact Customer Care at CustomerCare@GirlScoutsWW.org.

Group/Troop Number*

Name of Event/Destination*

Girl Scout Name*

Youth First NameYouth Last Name

Girl Scout Date of Birth*

MonthDayYear

Send Payment To*

If sending payments to EF Educational Tours, please include your EF Educational Tours account number to ensure payment is applied correctly.

Contact Name*

Contact Email*

Address (for mailing checks)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Caregiver Name*

First NameLast Name

Caregiver Email*

Phone Number*

Area CodePhone Number

Event Flyer, Invoices, and other documentation

Event Link or other additional documentation

Prior to entering Cookie Dough card information below, please ensure:

- Card is current and active

- Amount of available Cookie Dough is greater than or equal to amount requested

- Balance can be checked on key2prepaid.com or by calling the number on the back of the card

Amount of Cookie Dough to be Used*

USD

Payment Method

Cookie Dough Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Caregiver Request for Cookie Dough Use