Bank Account Request Form

Please complete this form to request a bank letter to officially open, change or close a bank account for a troop, group, service unit, Gold Project or travel account. Retain the email receipt.

Purpose of this Request: *

Open Bank Account Close Bank Account Change of Signee(s) Gold Project Account Travel Account for Troop/Group

Service Unit Number:

ex. 123

Troop/Group:

Regional Support Manager: *

Bank Name: *

Bank Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please note: The account will be opened by a minimum of two registered, unrelated adult volunteers using the Girl Scouts of NYPENN Pathways IRS Tax Identification Number.

Signer 1 Position: *

Co-Leader Troop Treasurer Service Unit Treasurer

Name of Signer 1: *

First Name Last Name

Signer 2 Position: *

Co-Leader Troop Treasurer Service Unit Treasurer

Name of Signer 2: *

First Name Last Name

Signer 3 Position:

Co-Leader Troop Treasurer Service Unit Treasurer

Name of Signer 3:

First Name Last Name

Open Bank Account

Please list the individual of who would like to receive these bank statements: *

First Name Last Name

Address of individual listed above: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have bank letter sent to this email: *

example@example.com

Closure of Bank Account

Bank Name: *

First Name Last Name

Bank Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Last Four Digits of Bank Account #: *

*When closing or making changes to a Troop/Group/Service Unit Bank Account, the last four digits of the account must be provided.

Reason for closing of Bank Account

Change of Signee(s) for Account

Bank Name: *

First Name Last Name

Bank Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Last Four Digits of Bank Account #: *

Please list the signee(s) to be removed from this Troop, Group or Service Unit Bank Account below in the boxes provided.

Signer being removed: *

First Name Last Name

Signer being removed 2:

First Name Last Name

Please list the signee(s) to be added from this Troop, Group or Service Unit Bank Account below in the boxes provided.

Signer being added: *

First Name Last Name

Position of Signer being added: *

Co-leader Troop Treasurer Service Unit Treasurer

Signer being added 2 (if necessary):

First Name Last Name

Position of Signer 2 being added:

Co-leader Troop Treasurer Service Unit Treasurer

Please list the individual of who would like to receive these bank statements: *

First Name Last Name

Address of individual listed above: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have bank letter sent to this email: *

example@example.com

Gold Project Account Request

When submitting this request, the account will be opened by a minimum of two registered, unrelated adult volunteers using the Girls Scouts of NYPENN Pathways IRS Tax Identification Number.

Is your Gold Project approved of? *

Yes-I have received confirmation on my Gold Project No-you are not ready to request a Gold Award bank account as you must have an approved project first

Girl Name: *

What is the name of your Gold Project? *

We will use the name of your Gold Project for the name of your Bank Account related

Name of Signer 1: *

First Name Last Name

Signer 1 Position: *

Co-Leader Troop Treasurer SU Treasurer

Name of Signer 2: *

First Name Last Name

Signer 2 Position: *

Co-Leader Troop Treasurer SU Treasurer

Please list the individual of who would like to receive these bank statements: *

First Name Last Name

Address of individual listed above: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have bank letter sent to this email: *

example@example.com

Travel Account Request

Name of Trip Leader: *

First Name Last Name

Anticipated number of girls attending: *

Please keep in mind the ratios. If you have any questions please contact your Regional Support Manager.

Anticipated Travel Dates *

Summary of projected travel plans and expenses: *

How will the group obtain the money for this trip? *

Banking information for opening a Travel Account with GSNYPENN Pathways.

Name of Signer 1: *

First Name Last Name

Signer Position 1: *

Co-Leader Troop Treasurer SU Treasurer

Name of Signer 2: *

First Name Last Name

Signer 2 Position: *

Co-Leader Troop Treasurer SU Treasurer

Please list the individual of who would like to receive these bank statements: *

First Name Last Name

Address of individual listed above: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have bank letter sent to this email: *

example@example.com