Bank Account Request Form

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
Who is submitting this request: *

First Name Last Name
Service Unit Number:
ex. 123
Troop/Group:
Regional Support Manager: *

Aimee Hilderbrant Amie Craft Grace Nassar Jessica Ginney Judi Knowlton Melissa Arthur Misty-Jo Osborn Renee Rivera Sadequa Fore Tiffany Blum Unknown
Bank Name: *
Bank Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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
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
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
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
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
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
Have bank letter sent to this email: *
example@example.com
Should be Empty: