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Reimbursement Form
This form is to be used for Cookie Dough, OC Bucks and Juliette Dollars reimbursement by Troops, Service Units, and Parents of Girl Scouts.
This form should be completed by a Troop/Group Leader, Troop/Group Treasurer or Parent.
Please see FAQs at www.gscookiesetc.org for more info.
**Cookie Dough submitted towards Camp Scherman Summer Resident/Weekends/GSOC events will be applied directly to the order instead of the amount being reimbursed**
**Girl Scout members wishing to use Cookie Dough, OC Bucks or Juliette Dollars for Day Camp must go through the Day Camp Director/Business Manager**
Make Check Payable To:
(ie: Service Unit, Troop #, or parent guardian name ):
*
Mail check, Care of
(ie: Service Unit, Troop #, or parent guardian ):
*
Address:
*
City and State:
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Zip Code:
*
Phone:
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Email
*
Confirm
Troop#
*
For events, attach a copy of the event flyer and registration receipt.
For Troop Travel, you MUST submit a copy of the Approved Travel Itinerary:
*
Add File
Attach a copy of your OC Bucks, Cookie Dough or Juliette Dollars - side with serial number only:
*
Add File
Please Select Event Type
*
Please select
Council Sponsored Event
Service Unit Sponsored Event
Troop/Group Travel
Camp Scherman Summer Resident Camp
Camp Scherman Weekend Camp
Community Day Camp
Council Service Fee
Girl Scout Lifetime Membership
Gold Award Expense
Silver Award Expense (Juliette Dollars only)
Fund Her Success Donation
Please Select Card Type
*
Please select
Cookie Dough
OC Bucks
Juliette Dollars
Please enter name of girl(s) and amount to redeem:
Girl Name
Voucher Number
Amount
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total Amount to Reimburse:
