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 the 2025/2026 membership year and all future membership years.

If any account signer or account information changes, a new 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*

Is this ACH for a Troop account or a SU account?*

TroopService 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?*

NEW: 2025/2026 and all future membership years (Initial submission)UPDATED: New banking/signer info from 2025/2026 initial submission

Sorry, the troop #'s do NOT match

Sorry, the account #'s do NOT match