Service Unit Event Council Credit Redemption Form

This form is only for Service unit event coordinators to complete. This form is collecting information on each individual Girl Scout who is using their Council Credit to pay for a Service Unit event. Please expect reimbursement 4-6 weeks after completing this form. If you are having any issues please contact gscookies@gsnorcal.org

Contact Information

SU Event Name: *

Person completing this form: *

Phone #: *

Email Address: *

Confirm: *

Make Check Payable to: *

Mail Check to (address): *

City: *

State: *

Zip Code: *

Reward Card/Council Credit Conversion Details

Girl's Name (1) *

Reward Card/Council Credit (1) # *

Council Credit Amount (1) $ *

Girl's Name (2)

Reward Card/Council Credit (2) #

Council Credit Amount (2) $

Girl's Name (3)

Reward Card/Council Credit (3) #

Council Credit Amount (3) $

Girl's Name (4)

Reward Card/Council Credit (4) #

Council Credit Amount (4) $

Girl's Name (5)

Reward Card/Council Credit (5) #

Council Credit Amount (5) $

Girl's Name (6)

Reward Card/Council Credit (6) #

Council Credit Amount (6) $

Girl's Name (7)

Reward Card/Council Credit (7) #

Council Credit Amount (7) $

Girl's Name (8)

Reward Card/Council Credit (8) #

Council Credit Amount (8) $

Girl's Name (9)

Reward Card/Council Credit (9) #

Council Credit Amount (9) $

Girl's Name (10)

Reward Card/Council Credit (10) #

Council Credit Amount (10) $

Electronic Signature

Electronic Signature By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement.

Please type your full name here: *

Published February 26, 2024

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.