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Cookie Program ACH Debit Authorization

PS COOKIE – ACH Debit Authorization

This form is to be used by all GSGLA Troops to authorize ACH debit transactions during the GSGLA Cookie Program (required).
Did your troop submit an ACH Authorization for the 2024 Fall Product Program?*
- Yes
- No
2024 Fall Product Participant
By signing below you attest that your troop banking information has not changed since you submitted for the Fall Product Program, including any signers on the account, and that you will not change accounts between now and April 15. (If there arises a specific reason an account must be changed – for example, it has been compromised – you will need to return to this form and complete a new ACH Authorization – you would click No to the question above to trigger the full e-form.)
Service Unit:*
Troop Number:*
Troop number should be 5 digits, no “#” or “-” symbols in the number please. Ex: 00123, 01416, 15224.
Troop Leader Name:*
First Last
Troop Leader Email:*
Enter Email Confirm Email
Name of Person Submitting*
First Last
Submitter Email*
Enter Email Confirm Email
Signature*
This form is to be used by all GSGLA Troops to authorize ACH debit transactions
during the GSGLA Cookie Program (required).
Via this form, please upload one of the following:

1. A copy of a troop check – make sure the account and routing numbers are clearly visible.

2. Or, a letter from the bank that includes the troop number, routing number and account numbers.

DO NOT upload deposit slips or the letter you received to open the account or any other documents or images. When entering your account number, DO NOT enter the check number.
Service Unit:*
Troop Number:*
Troop number should be 5 digits, no “#” or “-” symbols in the number please. Ex: 00123, 01416, 15224.
Troop Leader Name:*
First Last
Troop Leader Phone:*
Troop Leader Email:*
Enter Email Confirm Email
Bank Information
Bank Name:*
Other Bank Name:*
Bank Account Number:*
Bank Routing Number:*
Other Bank Routing Number:*
Voided Check:*
Or a letter from bank that includes troop number, routing number, and account number.

Is your file size too big to upload? Click here for a free file size reduction tool.
Max. file size: 50 MB.
Troop acknowledges and agrees to ACH:
1. GSGLA will debit the troop checking account according to the instructions provided during training for the current year’s Cookie Program.
2. The monies due for all Council proceeds will be debited in February and March (see Troop Guide for specific information and dates).
3. Troops are responsible to deposit sufficient funds to cover these debits, and will be responsible for any resulting non-sufficient funds (NSF) charges; signatories below agree to verify that troop funds are deposited into the bank account and available for withdrawal.
4. Troop expressly authorizes GSGLA to repeat debits that fail for any reason.
5. Troop agrees to work closely with GSGLA to pay all amounts due to Council in any manner agreed to by both parties.
6. Troops understand that they may not participate in the Cookie Program until ACH Debit Authorization is received by the Council.
This authorization must be signed by two (2) authorized check signers for the troop.
Signatory 1
eSignature:*
Date:*
MM slash DD slash YYYY
Position:*
- Leader
- Cookie Chair
Address:*
Street Address City State ZIP Code
Email:*
Enter Email Confirm Email
Primary Phone:*
Secondary Phone:
Have you completed the Council Background Screening?*
- Yes
- No
Signatory 2
eSignature:*
Date:*
MM slash DD slash YYYY
Position:*
- Leader
- Cookie Chair
Address:*
Street Address City State ZIP Code
Email:*
Enter Email Confirm Email
Primary Phone:*
Secondary Phone:
Have you completed the Council Background Screening?*
- Yes
- No
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