ACH Authorization Form

ACH Authorization Form

Complete and submit this form with a copy of a voided check attached in the "attach a file" section of this form. This document will placed in your troop file. Please note that troops are required to submit bank statements on an annual basis via The Volunteer ToolKit.
I am

Submitting this information for the first time to GSLPGUpdating the information that was previously on file with GSLPG.
Troop Number *
Information on the person received the Troop's monthy bank statements
Name*

First NameLast Name
DL Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Information on a second signee on the account
Name*

First NameLast Name
Troop Bank Account Information
Type of Account*

CheckingSavings
Bank Name*
Bank Account Number*
Bank Routing Number*
Upload an image of a voided check HERE*

Browse Files

Cancelof
E-signature*

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Should be Empty: