Outstanding Balance Report Form

Please select what you would like to do:
- Submit an ACH adjustment request to pay an amount other than 70% of the balance due for your troop ACH sweep.
- Submit an Outstanding Balance Form for your troop identifying the responsible party and additional details.
Form Options*

ACH Adjustment Request: ACH Sweep # 1 will take place April 21st. Fill out this form if you are requesting any other amount (above or below) 70% of total due.Outstanding Balance Form: Fill out this form if needing to adjust the balance that is to be swept from the troop account and/or provide GSMW with follow up details for caregivers who have an outstanding balance after the second sweep.
To make an ACH adjustment, please go to the ACH Adjustment Form to submit your request.
Outstanding Balance Report Form

Outstanding balance forms should be filled out and submitted to Council no later than the dates provided by GSMW for the program.*

Please select the responsible party for the outstanding balance: Troop or Caregiver

Troop

If you are reporting a troop outstanding balance, please select ‘Troop’, complete the form, and upload signed receipts for product delivered.
- In the event that your troop does not pay the balance, Council may need to involve a collections agency, in which case the volunteer who signed for the receipt of the product will be liable for the balance.
- PLEASE NOTE: This does not preclude responsibility for troop bank signers who are also responsible for managing funds.
Caregiver

If you are reporting a caregiver outstanding balance, please select ‘Caregiver’ and prepare to upload signed product receipts and the caregiver permission form.
- Documentation of three collection attempts is expected by the Troop Leader and/or Product Manager BEFORE submitting the caregiver outstanding balance form. You will be asked to detail those attempts in this form.
- PLEASE NOTE: The troop is not released of the financial liability of this outstanding balance until council has confirmed the required information and documentation have been completed.
^{*Don't have time to complete it all now? Just click the Save button to save a draft that you can come back to later. Choose "Skip Create an Account" if you don't want to create a Jotform account as there is no need to because an email will be sent to you with a link to your draft.}
Person Submitting Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Troop Number*
Your Troop Role*
Leader Name*

First NameLast Name
Leader Email*
example@example.com
Leader Phone Number*

Area CodePhone Number

Responsible Party for Outstanding Balance*

TroopCaregiver

Outstanding Balance Details - Troop
Financial Literacy Program*

Fall ProgramCookie Program
AMOUNT 1: Amount due to council*
See email from GSMW if you are unsure
AMOUNT 2: Amount currently available in bank account to sweep.*
This number cannot be lower than $100.
Remaining balance due after sweep*
Field will automatically calculate the remaining balance due.
Please detail out at least one amount and date for paying the outstanding balance.
Payment 1: Amount to Pay*
Estimated Date*

MonthDayYear
Date
Payment 2: Amount to Pay
Estimated Date

MonthDayYear
Date
Explain the reason why your troop ended up with a balance due. For instance: late money reason, approx. unsold box count, plans for selling, etc.*
Acknowledgement*

The financial liability for the outstanding balance detailed above is the responsibility of the troop. By checking this box, I understand that any remaining outstanding funds for the troop may impact the eligibility of troop volunteers and/or how the troop participates in future product programs. This includes troop bank signers, who may be removed from accessing the troop account, and product sales managers, who may be ineligible to participate in future sales seasons.
Signature*
Date*

MonthDayYear
Date
It is required that you provide GSMW signed receipts of product received.

NOTE: Using Google Chrome or Apple Safari are the preferred browsers to use for providing uploads. If you have trouble uploading them below, please reach out to customercare@gsmw.org.
*

Upload Receipts

Cancelof

Outstanding Balance - Caregiver Information
Acknowledgement*

By checking this box, I understand that the financial liability of the troop is released of this outstanding balance ONLY ONCE council has confirmed the completed information and documentation, including required receipts, have been received.
Girl Name*

First NameLast Name
Adult Responsible for Balance*

First NameLast Name
Adult Responsible Email*
example@example.com
Adult Responsible Phone Number*

Area CodePhone Number
Adult Responsible Address*

Street Address

Street Address Line 2

CityState

Zip Code

Outstanding Balance Details - Caregiver
Financial Literacy Program*

Fall ProgramCookie Program
AMOUNT 1: Total balance due from caregiver to troop*
AMOUNT 2: Funds paid to troop already*
Remaining balance due from caregiver*
Field will automatically calculate the remaining balance due.
Reason for Late Money*
It is required that you provide GSMW signed receipts of product received.

Please upload the following documentation for the outstanding caregiver:
- Signed receipts for product received by caregiver
- Caregiver permission forms
NOTE: Using Google Chrome or Apple Safari are the preferred browsers to use for providing uploads. If you have trouble uploading them below, please reach out to customercare@gsmw.org.
*

Upload Receipts

Cancelof

Collection Attempts

Documentation of three collection attempts is expected by the Troop Leader and/or Service Unit Manager BEFORE submitting this form to GSMW. Please document those attempts below.

Record of Attempts*

Rows	Date	Time	Method of Contact	By Whom	Outcome
Attempt # 1
Attempt # 2
Attempt # 3

Additional comments (if applicable)
Should be Empty:

Person Submitting Form

Outstanding Balance Details - Troop

Outstanding Balance - Caregiver Information

Outstanding Balance Details - Caregiver

Collection Attempts