Girl Scouts Louisiana East Corporate Headquarters 841 S. Clearview Parkway, New Orleans, LA 70121-3119 (504) 733-8220 (800) 644-7571 F (504) 733-8219 www.gsle.org Regional Service Center 545 Colonial Drive, Baton Rouge, LA 70806 (225) 927-8946 (800) 644-7571 F (225) 927-8402 ACH Authorization Form for Troop Bank Accounts If there are any changes to your troop’s bank account, a newly signed and dated form must be submitted to the GSLE Finance department. These changes include adding or changing signers on an account. Sample check detailing where the information can be found which will be necessary to complete this form. Bank Account Information Girl Scout Troop # _____________ Bank Name: ________________________________________________________________ Bank Routing # _______________________ Bank Account # _______________________ Email address to receive communications: ____________________________________ ACH Authorization I, ____________________________________________, authorize Girl Scouts Louisiana East, Inc (hereafter “GSLE”) to initiate credit and debit entries such as product sales payments, refunds, etc. to my account at the financial institution (hereafter “Bank”) indicated on this form. Furthermore, I authorize the Bank to accept and to credit entries indicated by GSLE. Moreover, I understand that troops are responsible for the timely deposit of collected funds to ensure adequate resources to cover all scheduled debits. The troop expressly authorizes repeat of any debit that fails for any reason. Troops that have delinquent families must follow procedures for debt notification to reduce scheduled debits. This ACH Authorization must be completed and submitted to GSLE, with a copy of a voided check prior to the start of the Cookie Program. Troops understand that they may not order or receive cookies until the ACH Debit Authorization has been received. This authorization is to remain in effect until this account is closed, or until GSLE has received written notification from an authorized signer of its termination. Authorized Signature ____________________________________________________________ An authorized check signatory on the troop checking account must sign this authorization. FOR OFFICE USE ONLY (Initial when entered) Date received __________ Date entered __________ Entered by __________ GSLE 07/14
© Copyright 2024 ExpyDoc
