Troop ACH Form

As an authorized signer on the financial institution account identified below, I authorize Girl Scouts of Northern
California (GSNorcal) to initiate electronic ACH (Automated Clearing House) transfers to debit the account identified below for financial transactions relating to the 2013 – 2014 Product Sales.

I also authorize GSNorcal to repeat any debit that fails for any reason, and understand the troop will be responsible for non-sufficient funds bank fees. This authorization remains in effect until total payment for the 2013 – 2014 Product Sale Programs have been received by GSNorcal.

Troop Information

Troop Bank Information

Signature and Acceptance

* Indicates Response Required