EmailMe Form - 2022-2023 Troop Banking Form

We authorize Girl Scouts of Orange County to electronically debit our account at the depository financial institution named below and, if necessary, electronically credit our account to correct erroneous debits. We agree that ACH transactions we authorize comply with all applicable law.

Is this your first Troop banking form submission since August 1, 2022? *

Yes

No - our bank information changed

Today's Date: *

MM / DD / YYYY

Troop Number *

Service Unit: *

Name of person
submitting this form: *

First Last

Your volunteer position: *

Your email address: *

(re-enter email to confirm)

Troop Bank Account Information:

Account Type: *

Checking

Savings (call your bank if unsure)

Bank Name *

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Routing Number: *

Checking Account Number: *

Example of where to find your routing number and checking account number:

Attach an image of a voided check from this account or documentation from the bank that includes the troop number, account number and routing number: *

The routing and account numbers on the check must be legible. This can be a picture of the check or a scanned copy. Your bank can provide you with a check for this purpose. Ensure Troop number has been written on check if not imprinted.

Funds owed to GSOC will be debited from the troop account. This includes any council proceeds due from participation in GSOC Product Sales programs. ACH debits may occur to verify bank information, accommodate payment plans, collections and ACH returns. The troop will incur fees for all NSF (Non-Sufficient Funds) fees incurred by rejected transactions.

The troop understands that this authorization will remain in effect until the troop notifies GSOC, by submitting a new Troop Banking Form online.

GSOC receives at least fifteen (15) days prior to the proposed effective termination date.

LIST THE NAMES AND PHONE NUMBERS FOR ALL VOLUNTEERS AUTHORIZED TO BE A SIGNER FOR THIS TROOP ACCOUNT.

All accounts must have 2 or more signers and signers must be registered as an adult member in the current year and have passed background screening. Signers may not be related by blood or marriage or living in the same household.

Signer One: Name *

First Last

Signer One: Phone *

### - ### - ####

Signer Two: Name *

First Last

Signer Two: Phone *

### - ### - ####

Signer Three: Name

First Last

Signer Three: Phone

### - ### - ####

Signer Four: Name

First Last

Signer Four: Phone

### - ### - ####

Please enter the name of the signer who is designated to receive the troop bank statement. *

First Last

By typing "yes" in the box below, I confirm I have double checked the entry of my banking information and understand incorrect banking information or failure to notify GSOC of bank account changes may result in a $15 processing fee. *