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:
Engagement Manager: *

Aimee Hilderbrant Caitlyn Berk Cheri Phillips Dolly LaClair Eileen Shultis Erin Murphy Grace Nassar Jessica Ginney Jillian Kerekes Judi Knowlton Lisa Kaminski Maureen Hayden Melanie Moon Melissa Arthur Miranda Nieto Misty-Jo Osborn Renee Rivera Sadequa Fore Samantha McCarthy Tonilynn Petrillose LeAnn Keim (Gold Awards)
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: