Bank Account ACH Electronic Credit/Debit Authorization Form

This form is authorization for GSHNC to secure Troop bank account information for the purposes of electronically sending reimbursements and collecting scheduled payments, including but not limited to Fall Product Program, Cookie Program, and financial aid requests.

Please provide the names and positions of the authorized signers on the troop bank account:

This information will be securely encrypted by Jotform and not sent via email.

Authorization form must be signed by an authorized signer for the troop.

Please acknowledge and agree to the following items:

• Authorize GSHNC to initiate credit and/or debit transactions associated with payments or reimbursements from the Troop bank account in accordance with program guidelines.
• ACH transactions may occur to verify bank account information, accommodate payment plans, collect scheduled payments, and send reimbursements or proceeds.
• The Troop is responsible for the timely deposit of all collected funds in Troop account to ensure adequate resources to cover all scheduled debits.
• The Troop will be responsible for all NSF (non-sufficient funds) fees levied by their bank resulting from rejected transactions.
• The Troop expressly authorizes GSHNC to repeat any failed transactions.
• The Troop agrees to notify Council and submit a new ACH Electronic Debit/Credit Authorization Form within 5 days of any Troop bank account change or in accordance with any program initiating the transaction (no changes during cookie season).
• This authorization will remain in full force and effective unless otherwise notified in writing by submitting a new ACH Electronic Debit/Credit Authorization form.