gshnj automated clearing house (ACH) payment permission

GSHNJ BANK ACCOUNT INFORMATION & AUTOMATED CLEARING HOUSE (ACH) PERMISSION FORM 2013

* Required


TROOP CHECKING ACCOUNT

Please provide the following information for your TROOP CHECKING ACCOUNT in the section below.











Names on account authorized to withdraw funds:

GSUSA requires more than one authorized person on Girl Scout Troop Accounts.










Permission of Troop Leader

I give permission for GSHNJ to withdraw payment from the above specified account for the 2013 Cookie program specified as follows - 50% of current balance on April 12, 2013 and the remaining balance on April 25, 2013.