EmailMe Form - 2023 Delinquency Report

2023 Delinquency Report

1. Submit a separate form for each parent who has any amount unpaid by the end of the Product/Cookie Program.
2. Complete all information, including the amount which was originally owed, and any amount paid to date.
3. Upload all contact attempts (emails, phone logs, etc.), signed Parent Responsibility form, and receipts.
4. Notify Service Unit Product/Cookie Manager you have submitted a Delinquency Report by noting submission in the body of the final Product/Cookie Program email.

Service Unit *
Troop # *
Troop Leader *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email: *
Position of person submitting this form *
Name of person submitting this form *
First Last
Email *
Phone *
### - ### - ####
Name of Delinquent Person *
First Last
Total $ amount owed to troop
Upload supporting documents here
Name of Girl Scout *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Home Phone
### - ### - ####
Cell Phone *
### - ### - ####
Work Phone
### - ### - ####
Email *
Delinquent Person Spouse's Name:
First Last
Home Phone
### - ### - ####
Cell Phone
### - ### - ####
Work Phone
### - ### - ####
Email
Troop has paid council *
Yes
No
If no, please complete the following questions.
Troop total $ amount due Council for product
Less any payment (paid by troop)
Amount still due Council (if any)
Please note if troop has payment plan with family or other information to share: