PAYMENT AGREEMENT

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 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.

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”.

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

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Date

Your full name

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