Juliette Program Credit Reimbursement

NOTE: Process may take up to 4 weeks to complete. Incomplete documentation will result in a processing delay.

Service Center *

Name of Girl Scout *

First Name Last Name

Juliette Number (if applicable)

Grade *

Parent/Guardian Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Description of Girl Scout activity and list itemized expenses: *

Attach receipt(s) of purchase(s) *

Amount of Juliette Program Credits to be reimbursed (Dollar Amount) *

PLEASE CHECK ALL BOXES TO SHOW ACKNOWLEDGEMENT