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 AUTHORIZE UNITED STATES OF AMERICA CORP. “DCICPA” TO SECURELY STORE MY CREDIT/DEBIT CARD OR BUSINESS BANK ACCOUNT INFORMATION. I UNDERSTAND AND AGREE THAT MY MONTHLY BUSINESS SERVICES FEE WILL BE AUTOMATICALLY CHARGED ON THE 15TH OF EACH MONTH. IF THE 15TH FALLS ON A WEEKEND OR BANK HOLIDAY, THE CHARGE WILL BE PROCESSED ON THE IMMEDIATELY FOLLOWING BUSINESS DAY.

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”

Amount (please type in the agreed monthly payment amount)

By clicking this box I authorize United States of America to charge the amount stated on amount box using my card on file or Bank account as a payment for my monthly Membership.

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.