ACH Agreement

ACH Authorization: Troops may choose to pay for GSH programs, events, camps, retail, and membership renewals for girls and adults with the troop bank account from American Savings Bank. Fill out and submit this form to authorize GSH to withdrawal funds from your Troop bank account. Mahalo!

Troop Number 0/0

Financial Institution 0/0

Branch Full Address 0/0

ACH Routing Number 0/0

Account Number 0/0

Voided-Check

Please upload an image of a voided check for this account.

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AUTHORIZED SIGNER ONE The Authorized Signer named here agrees to these terms, is a currently registered Girl Scout member, and authorized signer on the account listed above. 0/0

Authorized signer one email 0/0

Authorized signer one phone 0/0

AUTHORIZED SIGNER TWO NAME The Authorized Signer named here agrees to these terms, is a currently registered Girl Scout member, and authorized signer on the account listed above. 0/0

Authorized signer two email 0/0

Authorized signer two phone 0/0

Please confirm the Authorized Transfer Amount ($) Total 0/0

For Membership Renewals:

Attach your roster below or enter the full names of the individuals AND their membership type (adult or girl membership) being renewed with this ACH transfer.

For Programs/Events/Camps:

Enter the full name of individuals and their membership type for each event you are registering them for: (ie: Suzy Doe – STEM Fest Girl Member, Junior Camp Girl Member, etc.). You may elect to submit the ACH to register for multiple events but you must clearly identify which events and registration type for each listed member, spaces are limited and are not guaranteed until the ACH processing has been completed. You will receive a registration confirmation email after the ACH and registration is completed

For Retail:

Enter the item, quantity, size if needed. If you have questions about availability or items, please contact retail@gshawaii.org first.

Retail Info 0/0

Full Name/Adult or Girl Renewing Enter Names and Level (girl or adult) here if you are NOT uploading your roster for this request 0/0

Roster List or Upload

Roster

Attach roster with full names of individuals AND their membership type (adult or girl membership) for this ACH transfer

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Date submitting: 0/0

This form is not intended to represent a substitution to the Troop Bylaws or Annual Troop Finance Report policies and procedures. Furthermore, we understand that GSH will have access to all records pertaining to this account and the authority to close this account when in the best interest of the troop or Council. The Council will provide this Bank Account and ACH Agreement when opening or making changes to a Girl Scout account. Pertaining to ACH debits and credits, we hereby authorize GSH to initiate debit and credit entries and, if necessary, correction and adjustment entries to the troop account at the financial institution listed.