2024-2025 PRODUCT PROGRAMS ACH DEBIT AUTHORIZATION

2024-2025 PRODUCT PROGRAMS ACH DEBIT AUTHORIZATION
Troop
Service Unit
This form is to be used by Girl Scouts of Southern Nevada troops to authorize ACH Debit Transactions during the 2024-2025 Girl Scouts of Southern Nevada Product Programs. Failure to complete this form and return to your Service Unit Entrepreneurship Team Member or Council will result in a troop removal from the operating system of each Product Program. The Troop acknowledges and agrees to:
FALL 2024
1. Penny Sweep - Test ACH of $01 on Oct. 1, 2024
2. The First ACH (50% of balance owed to Council less troop proceeds) will be deducted on Oct. 29, 2024
3. The Final ACH (balance owed to Council less troop proceeds) will be deducted on Nov. 12, 2024
COOKIES 2025
1. Penny Sweep - Test ACH of $01 on Jan. 21, 2025
2. The First ACH (25% of balance owed to Council less troop proceeds) will be deducted on Feb. 11, 2025
3. The Second ACH (50% of balance owed to Council less troop proceeds) will be deducted on Feb. 25, 2025
4. The Final ACH (balance owed to Council less troop proceeds) will be deducted on Mar. 11, 2025
By checking the boxes, I confirm that I have read and agree to the guidelines for the 2024-2025 GSSNV Product Programs.

Troop is responsible for depositing sufficient funds to cover these debits and will be responsible for any resulting non-sufficient funds (NSF) charges.Any refunds to troops will be credited via ACH or by GSSNV Check.Troops explicitly authorize Girl Scouts of Southern Nevada to repeat debits that fail for any reason.Troops agree to work closely with Girl Scouts of Southern Nevada to pay all amounts due to Council.Troops understand that they may not participate in further Product Programs or Money Earning activities until GSSNV Council receives all ACH Debit Authorizations.This authorization is signed by an authorized check signer for the troop.
Financial Institution Name
Routing Number
Account Number
Printed Name
Position
Address

Mailing Address

Street Address Line 2

City ZipState / Province

Postal / Zip Code
Phone Number
Email Address
example@example.com
Authorized Signer Signature

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