Membership Application

Please complete the form below to request your membership subscription.

Once we receive your application, a member of our team will review your information and contact you to confirm the details and coordinate the payment process.

Thank you for your interest in our Professional Support and Bookkeeping Membership Plans. We look forward to helping your business grow with confidence.

OWNER’S FIRST NAME

OWNER’S LAST NAME

EMAIL ADDRESS:

PHONE NUMBER WITH AREA CODE:

IF SOLO-PROPRIESTORSHIP DBA:

PLEASE SELECT WITH X IF YOU ARE:

LIMITED LIABILITY COMPANY (LLC)

CORPORATION

LEGAL BUSINESS NAME

EIN

BUSINESS ADDRESS:

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

DEBIT/CREDIT CARD

CARD HOLDER’S NAME

Expiration Month

CVV / CVC

CARD NUMBER

Expiration Year

Street Address

Street Address Line 2

Region/State/Province

Postal / Zip code

City

BY CLICKING THIS BOX I AGREE THAT MY BANK ACCOUNT OR DEBIT/CREDIT CARD INFORMATION WILL BE KEPT BY UNITED STATES OF AMERICA CORP “ DCICPA “ IN ORDER TO BE USED TO CHARGE THE MONTHLY MEMBERSHIP FEE, WITHIN THE 1ST AND THE 8TH DAY OF EACH SUBSEQUENT MONTHS OR UNTIL THE MEMBERSHIP IS CANCELED. IN ORDER TO CANCEL THE MEMBERSHIP IT REQUIRES MINIMUM 30 DAYS NOTICE IN ADVANCE.

I AGREE THE USE OF MY BUSNIESS BANK ACCOUNT TO BE CHARGED MY MONTHLY MEMBERSHIP IN CASE MY CREDIT OR DEBIT CARD EXPIRES AND A NEW CARD IS NOT UPDATED.

I STATE I HAVE READ AND FULLY UNDERSTAD THE CONTENT OF THIS DIGITAL AGREEMENT. I CONSENT TO RECEIVE TEXT MESSAGES OR EMAIL FROM UNITED STATES OF AMERICA CORP. “DCICPA”

Your Signature

DATE required

YOUR FULL NAME:

Thank you for submitting your membership application.

Your information has been received successfully. Our team will review your application, and you will receive a confirmation email once your membership has been activated.

Thank you for choosing DCICPA. We look forward to supporting your business.