2026 Cookie- Debit Adjustment Form-2nd ACH

Debit Adjustment - 2nd ACH

2026 Cookie Program
Due March 5, 2026

Complete this form if your troop does not have the funds available to pay the council for the second ACH withdrawal.
Community*
Troop #*
Please enter exact troop number (e.g. 00123 not just 123)
Troop Leader*

First NameLast Name
Troop Leader Phone*
Troop Leader Email*
example@example.com
Troop Cookie Manager *

First NameLast Name
Troop Cookie Manager Phone*
Please enter a valid phone number.
Troop Cookie Manager Email*
example@example.com
Total calculated balance due council (Total amount on Troop Balance Summary)*
Amount available for withdrawal on March 5, 2026 (what can you pay now) *
Remaining balance due to council (subtract the amount available from the total calculated balance due council)*
Specific date the remaining balance can be debited*

MonthDayYear
Date
Reason for Request*
If you have been having difficulties collecting funds from a parent before the scheduled ACH by council, please notate the parent's name.

First NameLast Name
The undersigned agrees that the requested adjusted amount will be debited on the scheduled debit date as listed in the Troop Guide, and that the remaining balance due will be debited from the troop’s account on the date noted above. If either debit attempt is returned by the bank for any reason (including, but not limited to, insufficient funds (NSF)), the undersigned agrees that any fees incurred by the Council will be added to the balance due.
Requested By:*

First NameLast Name
Date*

MonthDayYear
Date
Email*
example@example.com
Signature*

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Debit Adjustment - 2nd ACH