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 GSLPG Updating the information that was previously on file with GSLPG.
Troop Number *
Information on the person received the Troop's monthy bank statements
Name *

First Name Last Name
DL Number *
Address *

Street Address

Street Address Line 2

City State / Province

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

Area Code Phone Number
Information on a second signee on the account
Name *

First Name Last Name
Troop Bank Account Information
Type of Account *

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

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E-signature *

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