Badgerland Bucks Reimbursement Form

Complete this form if you paid for an approved Girl Scout program or membership dues online and are seeking reimbursement for Badgerland Bucks. We will try to process a refund via the credit/debit card used for the initial payment if at all possible, but in the event that we are not able to do so you will receive your refund via check which will be mailed within 2-4 weeks of receipt of this form for all approved reimbursement requests.

Badgerland Bucks earned in the Fall 2025 Badgerland Fall Fundraiser and the Spring 2026 Cookie Program expire on September 30, 2026. All reimbursement requests must be received by September 30, 2026.

Name of the Girl Scout who earned the Badgerland Bucks:

First NameLast Name

Do you have their Badgerland Bucks card number?

Yes.No, please look it up for me.

Badgerland Bucks Card Number:

3-Digit Pin Number:

When were the Badgerland Bucks earned?

2025 Badgerland Fall Fundraiser.2026 Cookie Sale.I don't know.

Amount of Badgerland Bucks to be reimbursed from this card:

Do you have a second Badgerland Bucks Card you want to use?

YesNo

Do you have the Badgerland Bucks Card number?

YesNo, please have someone look it up for me.

Badgerland Bucks Card Number:

3-Digit Pin Number:

When were the Badgerland Bucks earned?

2025 Badgerland Fall Fundraiser.2026 Cookie Sale.I don't know.

Amount of Badgerland Bucks to be reimbursed from this card:

Who is being reimbursed? This is who will receive the reimbursement check.

The TroopAn Individual

Troop Number:

Name of Co-Leader who should receive the reimbursement check:

First NameLast Name

Individual's Name:

First NameLast Name

Address check should be sent to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

What are you requesting reimbursement for?

Online Membership DuesProgram or Camp Registration

Who is the membership(s) for?

Name of the Program/Camp Registrant(s):

Name of the Program/Camp(s):

Program/Camp Location and Date:

Email Address - Once this form is submitted you will receive a confirmation email:

example@example.com