2025 Fall Product Financial Discrepancy Report

Financial Discrepancy Report

2025 Fall Product Program
Complete and return to the Product Sales Department no later than November 16, 2025
Community
Troop Number*
Please attach original signed receipts as appropriate and retain copies of receipts for your records:
1. Receipts for any product ordered and/or signed for by this individual, including confirmation emails
2. Receipts for any payments made by this individual
The troop fall product manager must complete this form on any unpaid balances. The troop fall product manager can be held accountable for the unpaid balance unless the council receives this completed form and all required attachments by the due date.

The adult listed below will be held accountable for all money owed.
Owner of Financial Debt - Contact Information:
Name*
Registered GS Adult?*

YESNO
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number (Home)*
Please enter a valid phone number.
Phone Number (Work)
Please enter a valid phone number.
Phone Number (Cell)
Please enter a valid phone number.
Parent Email
example@example.com
Is this person a:*

Parent / GuardianOther
Girl Scout’s Name*

Explanation of Discrepancy:*

	Nuts/Candy Amount ($)
Cost of total items ordered by parent
Amount paid to date
Total Amount Outstanding

Actions Taken to Date (please list phone calls, text messages and email communications etc. and attach copies of all written communications
Reason Provided for Discrepancy (a legal incident/police report must accompany this form):*

FireFloodRobberyOther
Other:
Supporting Documentation is Required:
Please attach copies/documents of all written communications including phone calls, text messages and emailcommunications, etc.

Cancelof
Contact Information of person completing this form:*

First NameLast Name
Position*
Phone Number (Home)*
Please enter a valid phone number.
Phone Number (Work)
Please enter a valid phone number.
Phone Number (Cell)
Please enter a valid phone number.
Email*
example@example.com
Date Completed*

MonthDayYear
Date
Submit this completed form along with documentation by Nov. 16, 2025
Should be Empty:

Financial Discrepancy Report