Girl Scouts of CT ACH Form

Girl Scouts of Connecticut Electronic Payment (ACH) Authorization Form

This form should be completed by an authorized signer on the Troop's/SU's bank account.

By providing the requested information below, you authorize GSOFCT to debit your troop's bank account for the total amount due. In the event that the troop is due a credit, GSOFCT will use the banking information provided to credit/return any monies due.

This banking information will be used to initiate withdrawals for all GSOFCT financial transactions including, but not limited to, Product Sales Programs, for NEW Troops for the current membership year and all future membership years, and for current troops with signer or account changes.

If any account signer or account information changes, an updated ACH will be required.

Troops/SUs are responsible for depositing sufficient funds into their identified account to cover all electronic withdrawals. Deposits into the Troop/SU account should be made in a timely manner to ensure the funds are available for all scheduled ACH transactions.

If funds are not available at the time of the scheduled ACH transaction, the Troop/SU may be charged a fee by their bank. GSOFCT is not responsible for these fees.

Troops/SUs authorize GSOFCT to repeat electronic transactions that fail, for any reason, within five business days.

* Fields are required for submission.

Name

First NameLast Name

Service Unit Name

If this ACH is for a Troop account, and you are the troop leader, click "Troop". If this ACH is for the SU, and you are a SU leader, check "Service Unit".

5 Digit Troop Number

4 Digit SU Number

Position in Troop

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

E-mail

Confirmation Email

Re-enter 5 Digit Troop

Is this a New or Updated ACH form?

Sorry, the troop #'s do NOT match

Sorry, the account #'s do NOT match