2026 Delinquent Account form

Date of submission*

MonthDayYear
Date
Who is completing this form: (name, email, phone number):
Fill out a Delinquent Account form prior to the final ACH for each person who owes money for cookies. Submitted forms must include ALL supporting documentation. Delinquent Account forms will NOT be accepted by GSHG after March 10th for Final ACH.

The following supporting documentation MUST be provided:
- Delinquent Account form
- Copies of ALL receipts for cookies/payments
- A copy of the signed Product Program Parent Permission form
- All correspondence(s) - including emails, texts, etc. Responsible Party (circle one): Parent/Caregiver Troop Cookie Program Manager
Responsible Party (select one):*

Parent/CaregiverTroop Cookie Program Manager
Troop #*
Responsible Party Name*
Girls Names
Address*

Home Address

Street Address Line 2

CityState / Province

Zip
Home
Cell*
Work
Email*
example@example.com
Select all that apply:*

Parent Permission Form submitted to Council?Troop Debt and Parent Debt forms submitted to Council?Signed product receipt(s) attached?
Troop Cookie Program Manager is responsible for debt if no paperwork is provided!!
Original Amount Due*
Payments Made to Date*
Current Due*
Please provide communication notes below:
Contact Type
Date

MonthDayYear
Date
Time
Notes:
Contact Type
Date

MonthDayYear
Date
Time
Notes:
Should be Empty: