Bank Account Request Form

Bank Account Request Form
Please complete this form to request a new troop bank account, make changes to your current bank account, or close your troop bank account. If this is a service unit request, please put the SU number in both SU and Troop boxes. Once we receive your request, we will email you the documents needed and specific instructions regarding the next steps.

Each bank account is opened using the Girl Scouts of NYPENN Pathways IRS Tax Identification Number and requires:

- a minimum of two, unrelated adult signers.
- each signer must be a registered member of Girl Scouts with a current background check on file with the Council.
- completion of the New Leader Orientation.

Banks will require an ID. Please confirm with your other signer(s) to make sure the names and street addresses match the information you provide below. To avoid delays, make sure all emails provided are correct as all documents are sent via email.
Purpose of this Account:*

Open Bank AccountClose Bank AccountChange Signer(s) on Bank Account

Who is submitting this request:*

First NameLast Name
Service Unit Number: *
ex. 123
Troop Number: *
Membership Manager:*

Becky WrightCallista CarrierCrystal JacksonDolly LaClairErica RaymondJensyn Burton-PentaLeah BardoMarnie ShaefferRenee RiveraSabrina ClemensSarah GrahamOther
Open Bank Account
If you are changing bank accounts to use one of our preferred banks, please select from the following options: *

We are closing our current bank account and depositing the funds into our new account.Does not apply.
Preferred Bank Name:*

Community BankNBT BankLyons National Bank
If you do not have one of the preferred banks within 15 miles, please contact Misty Jo Osborn via email at mosborn@gsnypenn.org.
Bank Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Would you like online banking access for this account?

YESNO
Name of Primary Signer (person receiving statements):*

First NameLast Name
Primary Signer Position:*

Troop Co-LeaderTroop TreasurerService Unit TreasurerOther
Address:*

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Zip Code
Phone Number: *

Area CodePhone Number
Email: *
example@example.com
Name of Signer 2:*

First NameLast Name
Signer 2 Position:*

Troop Co-LeaderTroop TreasurerService Unit TreasurerOther
Address: *

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Zip Code
Name of Signer 3 (if applicable) :

First NameLast Name
Signer 3 Position:

Co-LeaderTroop TreasurerService Unit TreasurerOther
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Closing Bank Account

Please upload your most recent bank statement if you do not use NBT Bank or Community Bank. If you have already closed your bank account, please also include the receipt showing the account has been closed with a zero balance.
Upload any bank statements or receipts required below.

Browse Files

Cancelof
Reason for Closing Bank Account*

Switching to a Preferred BankTroop DisbandingTroop MergingOther
Please click the "BACK" button below and select "Open Bank Account" from the main page and follow prompts.
Please list all girls that were troop members before disbandment below.*
What Troop will you be merging with?*
If any girls are moving to new troops, please provide their name and new troop number, if known:
Bank Name: *
Bank Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Last Four Digits of Bank Account #:*
*When closing or making changes to a Troop/Service Unit Bank Account, the last four digits of the account must be provided.
Comments:
Change Signer(s) on Bank Account
Bank Name: *
Bank Address:*

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Postal
Last Four Digits of Bank Account Number:*
Please list all current signers on this troop bank account: *
Who is to be listed as the Primary Signer on Account: *

First NameLast Name
Primary Signer Address: *

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Zip Code
Phone Number *

Area CodePhone Number
Email *
example@example.com
Please list the signer(s) to be removed from this Bank Account below in the boxes provided.
Signer being removed:*

First NameLast Name
Signer 2 being removed (if applicable):

First NameLast Name
Please list the signer(s) to be added from this Bank Account below in the boxes provided.
Signer being added:*

First NameLast Name
Position of Signer being added:*

Troop Co-leaderTroop TreasurerService Unit TreasurerOther
New Signer Address: (If the Primary Signer is also the New Signer, skip to Phone Number)

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Zip Code
New Signer Phone Number: *

Area CodePhone Number
New Signer Email: *
example@example.com
Do you need to add a second signer to this bank account?

YesNo
Signer 2 being added:

First NameLast Name
Position of Signer 2 being added:

Troop Co-leaderTroop TreasurerService Unit TreasurerOther
Address:

Street Address (cannot use PO Box only)

Street Address Line 2

CityState

Zip Code
Phone Number:

Area CodePhone Number
Email:
example@example.com
Comments or Special Instructions:
Should be Empty: