EmailMe Form - 2026 Counterfeit Bill Report

Service Unit *

Girl Scout Level *

Troop # *

Troop Treasurer or Troop Leader *

First Last

Address *

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

Phone

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

Email *

Name of Person Filling Report *

First Last

Address *

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

Phone

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

Email *

Location where bill was received *

Booth Sale

Walk About/Door to Door

Other

If Booth Sale, please complete the following sections.

Date of Booth Sale

MM / DD / YYYY

Time of Booth Sale

Booth Sale Location

Booth Sale Address

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

Total $ amount of counterfeit bill *

Receipt received from bank or police *

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