GSGATL Unpaid Parent Account Form

This form should only be used by a troop to submit proof of an uncollectable balance due from an individual girl/parent for a Girl Scouts of Greater Atlanta (GSGATL) sponsored Product Program (Girl Scout Cookies or Treats & Keeps). Submission of this form with the required supporting documentation by the designated deadline will remove the troop’s financial responsibility to cover the balance due for the identified girl/parent who have not fulfilled their payment obligation to the troop.

Use when:
- A troop is unable to collect product payments from an individual girl/parent for a current GSGATL Product Program activity (the Girl Scout Cookie Program and/or Treats & Keeps).
- All attempts to collect an unpaid debt from an individual girl/parent have been exhausted by the troop.
Submit by:

The Unpaid Parent Account Form along with supporting required documentation should be sent to GSGATL’s Product Programs Team for the corresponding program at:
- Cookies@gsgatl.org by May 31
- Treatsandkeeps@gsgatl.org by December 15
All documentation noted below must be attached to the Unpaid Parent Account Form. Submissions of the form that do not include the required documentation outlined below WILL NOT be acceptable forms of documentation to relieve the troop from absorbing the total balance due GSGATL.
Required Documents:

• Copy of signed product receipts verifying the amount of product issued that will support amount of uncollected funds

• Copy of signed payment receipts verifying the amount of money collected (if any) that will validate the amount of uncollected debt

• Proof of at least 5 attempts to collect the balance due with a minimum of 3 of those attempts in writing. Other acceptable forms of collection attempts can include phone or in-person conversations, text messages, reminders via phone or email and printed troop updates, etc.

Debtor/Parent Information
Parent/Guardian Responsible for Debt*

First NameLast Name
Debt Submission for:*

Girl Scout Cookie ProgramGirl Scout Treats & Keeps Program
Total Items Received*
Chocolate/Nuts or Boxes of Girl Scout Cookies
Original Amount Due $*
Total Payments Made $*
Remaining Balance $*
Parent Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent E-mail*
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
Place of Employment (if known)
Driver's License # and State (if known)

Girl Information
Troop #*
Girl Scout's Name*

First NameLast Name
Girl's Address (if different from parent)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Attempts to Collect
Use log below to enter the dates of communication with the parent regarding payment of the amount due.

Use the additional space provided to provide the details of your collection efforts.

Note: 5 attempts to communicate and recoup the balance due with at least 3 attempts in writing is required.
Letter
Phone Call
Email
Text
Other
Additional Details
Upload all supporting documents below. These documents should include, signed receipts for products issued/received, signed receipts for payments made, proof of communication of debt/balance due, etc. (All file types accepted)
Upload files here:*

Leader/Program Manager Info.
Name of person completing this submission*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*

Area CodePhone Number
Email*
example@example.com
Role in Troop*

Troop LeaderTroop Product ManagerTroop TreasurerOther

Review & Submit
Submission Checklist*
The information being submitted to GSGATL is valid and true. All documents provided were acquired through the standard means of participation in the council sponsored product program.*
Signature

Clear
Should be Empty:

Debtor/Parent Information

Girl Information

Attempts to Collect

Leader/Program Manager Info.

Review & Submit