PAYMENT AGREEMENT

Payment Agreement

Please complete the requested information by filling in all applicable lines below.

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

SOLO PROPRIETORSHIP:

OWNER’S FIRST NAME

MIDDLE NAME

OWNER’S LAST NAME

EMAIL ADDRESS

PHONE NUMBER WITH AREA CODE:

SOLO OR CORP

SOLO-PROPRIETORSHIP

LIMITED LIABILITY COMPANY OR CORPORATION

IF SOLO-PROPRIETORSHIP DBA

LIMITED LIABILITY COMPANY OR CORPORATION:

LLC OR CORPORATION’S LEGAL NAME REGISTERED WITH SECRETARY OF STATE AND IRS

LLC OR CORPORATION’S EIN

BUSINESS PHONE NUMBER

BUSINESS EMAIL

BUSINESS ADDRESS:

BUSINESS ADDRESS

Country/Region

Address

Address - line 2

City

Zip / Postal code

DEBIT/CREDIT CARD OR BANK ACCOUNT INFORMATION

MARK X IF YOUR CARD IS A

DEBIT CARD

CREDIT CARD

BANK ACCOUNT

CARD HOLDER’S FULL NAME

CARD NUMBER

EXPIRATION MONTH

EXPIRATION YEAR

CW/CVC

BANK STATEMENT OR CREDIT CARD STATEMENT’S ADDRESS

Multi-line address

Country/Region

Address

City

Zip / Postal code

By Clicking this box, I agree that my Credit/Debit Card or Business Bank Account

will be kept by United States of America Corp. “DCICPA” to be used to process my

monthly Business Services amount within the 1st and 8th day of every consequent

Month.

By clicking this box, I state that I have read and fully understand the content of this

digital Agreement. I consent to receive text messages or emails from United States of

America Corp. “DCICPA”.

NOTE: Once the payment is processed and received, an Invoice will be sent to your email, or Text Message. Thank you.

Your Signature

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Date

Your full name