Product Program Bad Debt Form

Outstanding Debt Report

Important: Council will only start the collection process if the signed Parent Permission Slip , receipts, and mail/text conversations are attached.
Service Unit Number
Troop Number
Date

MonthDayYear
Date
Troop Leader or Troop Cookie Coordinator
Telephone
Format: (000) 000-0000.
Email
example@example.com
Person Completing form
Position
Email
example@example.com
Telephone
Format: (000) 000-0000.
Fill out this section for the Responsible Party's Information

This is the person that is responsible for the debt
Responsible Adult
Girl Scout’s full name
Address

Responsible Party’s address

Street Address Line 2

CityState / Province

Zip
Home Telephone
Format: (000) 000-0000.
Cell
Email
example@example.com
Core cookies ($5.00)
# of boxes
Specialty Cookies ($6.00)
# of boxes
Total Amount of Money Due
Type any collection attempts or notes that we may need:
Upload any receipts or copies of text messages

Cancelof
Council will contact you on any next steps or information that may be needed. Keep all text or emails until told otherwise. If the person pays off the debt contact council so they can close the case.

If you need to ask any further questions reach out to Product Programs at ttudder@gsmidtn.org
Should be Empty:

Fill out this section for the Responsible Party's Information