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 IDWhich Program are you submitting for?* 2021 Fall Product 2022 Cookie Program Date:* MM slash DD slash YYYY Service Unit:*203 Journey Girls - LB204 Journey Girls - ARC204 Journey Girls - UPL400 Rancho Foothills401 Alhambra/Rosemead402 Bonita403 Claremont404 Anita Oaks/Mission Camellias405 Chino406 Canon Trails/Rio Hondo407 CV/Glendale408 Pomona409 River Trails411 Upland412 La Canada414 Monrovia/Duarte415 Las Caballeras416 Puente Hills418 San Marino419 Glendora420 South Pasadena421 Covina Oaks422 West Covina425 Crown Poppy426 Mountain View427 Campo Verde428 Ontario/Montclair429 Gateway450 Las Colinas501 Compton/Lynwood502 Bellfower/Hollymount503 Belmont504 Lachen505 Holly Hills506 Wilshire Park Village507 Lakewood508 Alamitos/Marina509 Westchester/Del Rey511 Culver City512 RDE/Sil-Dom513 Northeast Hills515 El Segundo516 East LA517 Southeast518 Center City519 Lawnthornes522 La Brea Heights524 King Harbor526 North Redondo Beach528 Manhattan Beach529 South Bay Four533 Marina538 Palisades/Malibu540 San Pedro542 Santa Monica Bay543 South Torrance545 North Torrance546 PV/Peninsula601 Burbank604 Westside605 Rancho Calabasas606 Las Virgenes608 Palmdale612 Golden Savannahs616 Canyon Star617 Sagebrush624 Woodland Hills636 Kern640 Mission Rose641 Twin Oaks642 Heart of the Valley643 Stoneyridge644 Magnolia647 Lancaster649 Coyote Canyon650 North RiverUnsure or N/ATroop Number (Five Digits):* Troop Contact InformationTroop 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 TroopTotal In-Person Sales:*$ Do not include online orders (shipped or girl delivered), only those from the paper order card or transferred from any extrasthe troop ordered. Total In-Person Sales:*# of ItemsDo not include online orders (shipped or girl delivered), only those from the paper order card or transferred from any extrasthe 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 Documentation1. Signed Parent Permission Slip & Responsibility Form2. Signed receipts for product and payments3. Girl transaction record from eBudde4. Any correspondence (phone calls, texts and/or emails) Drop files here or Select files Max. file size: 200 MB. 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 byName:* First Last Signature:*CAPTCHA
