Electronic Payment Authorization Form

2022 Treats & Keeps Program AND 2023 Cookie Program

This form will be used to authorize your payments to GSGATL for both product programs!



This form should ONLY be completed by an authorized signer on the troop's bank account. If you are not an authorized signer on the account, please share with the appropriate individual for completion. By providing the requested information below, you as signatory on the Troop's bank account, authorize debit and credit transactions as part of the Troop's participation in the 2022 Treats & Keeps and/or the 2023 Girl Scout Cookie Program.

Before proceeding:

I Agree*

Your Information

Troop Number Only
Mailing Address*
Position in Troop*
Check all that apply

Troop Bank Information

Use Banking Information for:*

Sample Check Image

Text
Numbers only
Numbers only

By signing below, you agree that you, as the Troop signatory, have read and understand the Terms of Agreement for electronic payments initiated by Girl Scouts of Greater Atlanta and have provided accurate and complete account information.

Use your mouse or finger to draw your signature above
Date/Time*
:  

Final Step...Verify Your Information

Before you submit, verify the banking information you have provided.

  • If this information is not correct, click the "Previous" button to make changes 
  • When you have confirmed your banking information is correct, finalize your submission by clicking SUBMIT.

 

Troop #: {$126724205 ‪Troop #‬}

 

Service Unit: {$126724206 ‪Service Unit‬}

 

Use Banking Information for: 

{$126724213 ‪Use Banking Information for:‬}

 

Bank Name & Routing Number Selected from Dropdown Menu:

{$126724215 ‪Bank Name & Routing Number‬}

 

Manually Entered Bank Name: {$126724216 ‪Bank Name‬}     

Manually Entered Routing Number: {$126724217 ‪Bank Routing Number‬}

 

Account Number: {$126724218 ‪Bank Account Number‬}

 

 

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