Girl Scouts of Gulfcoast Florida, Inc.
Girl Scout Juniors, Cadettes, Seniors, and Ambassadors can bank (save) Cookie Dough for approved Girl Scout activities. Each girl must submit this form to the council headquarters to initiate the disbursement of funds, or to request the banking of cookie dough.
Parent/Caregiver Phone Number
Email that was used when registering
Amount of Cookie Dough Requested
Cookie Dough Card Number (if applicable)
Funds requested for
Please bank my cookie dough (Juniors and above)
Girl Scout Membership Renewal (Must have a minimum of $25 in Cookie Dough to request membership renewal.)
Troop Travel (100+ miles)
Council or service unit sponsored program
Girl Scout Bronze, Silver, or Gold Award expenses
GSUSA Lifetime Membership
Troop Travel: Location and dates of travel
Attach copies of all receipts
Destinations: Location and dates of travel
Camp: Name of session and date(s). When attending a camp at another council other than GSGCF, please provide name of council/address/city/zip code in the box below in order for payment to be disbursed.
Council or service unit sponsored program: Name of program and dates
Amount of Cookie Dough to be banked
Girl's electronic signature: please fill in your full name
Parent/Caregiver's electronic signature: please fill in your full name
Please input a 5 digit code known only to you to affirm that all the above statements are true and this is your electronic signature. Make sure you keep this personal identification number for future correspondence.
Must be between
FOR OFFICE USE ONLY:
Cookie Dough verified: ______
Amount available $ _______
Approved to apply by director: Initials ______ Date ___/____/____
Disbursement completed: Initials ______ Date ___/____/____
Cookie Dough applied on spredsheet: Initials ______ Date ___/____/____
Do Not Fill This Out