2027 Cookie- Debit Adjustment Form-2nd ACH

Debit Adjustment - 2nd ACH

2027 Cookie Program
Due March 4, 2027

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
Format: (000) 000-0000.
Troop Leader Email
example@example.com
Troop Cookie Manager

First NameLast Name
Troop Cookie Manager Phone
Please enter a valid phone number.Format: (000) 000-0000.
Troop Cookie Manager Email
example@example.com
Total calculated balance due council (Total amount on Troop Balance Summary)
Amount available for withdrawal on March 4, 2027 (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
2 digit month, 2 digit day, 4 digit yearDate
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 starting March 4, 2027, 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
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Signature
Should be Empty:

Debit Adjustment - 2nd ACH