Discrepancy Report for Product Program

Please complete this form if you have a parent who owes you money to the troop for the Fall Product
Program or Cookie Program (do not use this form for other payment issues).
You will be asked to provide documentation - copies of: signed Parent Permission and Responsibility
Agreement, signed receipts (for money and/or product), any email or text conversations, details
on phone conversations, etc.
Unique ID
Which Program are you submitting for?*
- 2020 Fall Product
- 2021 Cookie Program
Date:*
Date Format: MM slash DD slash YYYY
Service Unit:*
Troop Number (Five Digits):*
Troop Contact Information
Troop Leader Name:*
First Last
Troop Leader Phone:*
Troop Leader Email:*
Enter Email Confirm Email
Troop Product Chair Name:*
First Last
Troop Product Chair Phone:*
Troop Product Chair Email:*
Enter Email Confirm Email
Service Unit Product Chair Name:*
First Last
Service Unit Product Chair Phone:*
Service Unit Product Chair Email:*
Enter Email Confirm Email
Monies Due to Troop
Total In-Person Sales:*
$

Do not include online orders (shipped or girl delivered), only
those from the paper order card or transferred from any extras
the troop ordered.
Total In-Person Sales:*
# of Items
Do not include online orders (shipped or girl delivered), only
those from the paper order card or transferred from any extras
the troop ordered.
Amount Collected to Date:*
$
Amount Collected to Date:*
# of Items
Amount Still Due:*
$
Amount Still Due:*
# of Items
Attach Supporting Documentation:*
Checklist of Supporting Documentation
1. Signed Parent Permission Slip & Responsibility Form
2. Signed receipts for product and payments
3. Girl transaction record from eBudde
4. Any correspondence (phone calls, texts and/or emails)
Drop files here or
Explanation of Discrepancy:*
Actions Taken to Date:*
Information Concerning Debtor:
Name:*
First Last
Registered GS Adult?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Phone:*
(Day)
Phone:
(Eve)
Email*
Enter Email Confirm Email
Is this person a:*
- Parent/Guardian
- Other
Other:*
Girl Scout's Name:*
First Last
Report Submitted by
Name:*
First Last
Signature:*
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Discrepancy Report for Product Program

Troop Contact Information

Monies Due to Troop

Information Concerning Debtor:

Report Submitted by