ACH Debit Authorization 2024-2025

ACH Debit Authorization 2024-2025

(must be completed yearly)
GIRL SCOUTS OF NASSAU COUNTY, INC.

110 Ring Road West Garden City, NY 11530-3296 T 516-741-2550 ; F 516-741-2207
ACH Debit Authorization

This form is to be used by ALL GSNC troops to authorize ACH transactions during the 2024 Mags&Munchies Program and the 2025 Cookie Program. The two Troop volunteers named on the bank account need to submit one ACH form each from their individual email accounts. However, if the Troop changes bank accounts a new form must be submitted within 5 business days of the change. To participate in both Mags&Munchies/Cookie Program, complete all parts of this form. Forms received by October 4, 2024 will count toward the criteria for the 2024 Mags&Munchies troop bonus. Forms received by January 14, 2025 will count toward the troop proceeds bonus for the 2025 Girl Scout Cookie Program. Form and required account verification (bank letter or voided check) MUST be completed and attached. If you have a question, please email customercare@gsnc.org.
TROOP ACKNOWLEDGEMENT AND AGREEMENT
Troop # (troop#)* acknowledges and agrees that:
1. GSNC will debit and/or credit the bank account listed below according to the instructions and dates provided during training and in the Troop Manager's Manuals for the 2024 Mags&Munchies Program and the 2025 Cookie Program.
2. To delay or reduce any scheduled payment, Troop must notify Council in accordance with the procedures set forth on the ACH Adjustment Form.
3. If funds are not available and the ACH adjustment form has not been submitted as per Council procedures, Troop will be responsible for any resulting non-sufficient funds (NSF) charge from their own bank and a GSNC fee of $25.00 per sweep.
4. Troop authorizes GSNC to perform additional sweeps after failed attempts.
5. Troop agrees to follow Troop banking procedures as listed in GSNC Volunteer Essentials.
6. In the event of multiple failed sweeps, Troop agrees to work closely with GSNC to pay all amounts due to Council. If a written agreement cannot be reached in a timely manner penalties disclosed within GSNC Volunteer Essentials will be enforced.
Bank Account Information (Checking Account Only)
Bank Name:(bank name)*
Branch Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Account Number:(account number)*
Routing Number: (routing number)*
I hereby authorize, Girl Scouts of Nassau County, Inc. to withdraw amounts owed to them by Troop (troop #)*for the Mags&Munchies Program and/or the Girl Scout Cookie Program.
Please attach one of the following account verification:
(choose one)*

Voided Check (no starter check accepted).Bank letter or specification sheet (See your local bank representative) which includes bank letterhead, troop number, account number and routing number.
File Upload*

(upload either a voided check or bank letter)
Cancelof
This authorization must be signed by the troop leader and co-leader as authorized check signers for the troop.

I understand that I am responsible for all monies collected by me from the Girl Scouts/parents/guardians/troop sales, and that said monies must be deposited in my Troop’s bank account and must be available on the published date of the ACH sweep. In the event of non-payment, I understand that Girl Scouts of Nassau County reserves the right to initiate collection procedures by its designated agent, including civil suit and criminal prosecution on delinquent accounts. I further understand that all costs associated with the above-mentioned collection process, include an additional 30% fee, and any attorney fees incurred, will be my responsibility.
Troop #:(troop #)*
Service Unit: (Service Unit)*
Date*

MonthDayYear
Date
Troop Leader's /Co-Leader's Full Name*

First NameLast Name
Troop Leader's/Co-Leader's Email*
example@example.com
Troop Leader's/Co-Leader's Phone Number*
Please enter a valid phone number.
Electronic Signature: I understand that typing in my name below under 'electronic signature' acts as a binding signature to this form and that I am the person whose name appears on this form.*

First NameLast Name
Should be Empty:

ACH Debit Authorization 2024-2025

GIRL SCOUTS OF NASSAU COUNTY, INC.

ACH Debit Authorization

TROOP ACKNOWLEDGEMENT AND AGREEMENT

Bank Account Information (Checking Account Only)

Please attach one of the following account verification:

This authorization must be signed by the troop leader and co-leader as authorized check signers for the troop.