Pueden clic en las banderas de la esquina inferior izquierda de esta página para cambiar entre inglés y español. This application is for DSA Tax & Bookkeeping Service only. For Business Formation services, see the Incorporation application. Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact:*Home PhoneCell Phone Email* Alternate Email Owner's Social Security #* Bakery & Route InformationHiddenManufacturer you Distribute for Manufacturer you Distribute for*Please ChooseAmorosoBestfoods BakingBimboBimbo-EarthgrainsFlowersFreihoferGold MedalGWHolsumH&SLandshireLittle DebbieMartinsMissionPepperidge FarmPerfection/Aunt Millie'sSchmidtSnyder-LanceUtzOtherRoute Purchase Status*Please ChooseI have recently purchased my route on the date listed below...I have not yet closed on my route, but expect to on the date listed below...I closed on my route years ago, I am up to date on my taxes, but looking to switch to DSA.I closed on my route years ago, and I need help getting caught up with my taxes.Closing Date MM slash DD slash YYYY Route # District / Depot Manager If already a Corporation or LLCBusiness NameEINState of FormationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificIncorporation Date MM slash DD slash YYYY Attaching Documents?Please upload Closing Statements and Articles of Incorporation, if available. Closing Statements Drop files here or Select files Max. file size: 128 MB. Articles of Incorporation Drop files here or Select files Max. file size: 128 MB. Payment AuthorizationIn order for your application to be complete you must sign up for Recurring Automatic Payment. Please click Automatic Recurring Payment to sign up for monthly credit card charges. Monthly fees are $125 for Corporations and $104 for Sole Proprietors.DSA Tax & Bookkeeping fee:* Checking this box authorizes weekly settlement deduction Weekly settlement fees are $32/week for Corporations and $24/week for Sole Proprietors.By signing below, I (“Customer”) hereby authorizes Distribution Services of America, Inc., DSA Tax & Bookkeeping Inc., (a “Company”)”), to the extent Customer has engaged the Company with regard to the products or services it offers (“Services”), to utilize Bimbo Foods Bakeries Distribution, LLC (“BFBD”) or Earthgrains Distribution, LLC (“EGD”) as a non-exclusive agent for the purpose of collecting money owed by Customer to the Company related to the Services rendered by Company. Customer represents and warrants that Customer has either i) signed a distribution agreement with BFBD or EGD dated January 1, 2023 or later in which, among other things, it granted BFBD or EGD permission to withhold/collect money from Customer on behalf of the Company related to the Services, if any or ii) signed an Assignment of Receivables and Deduction Authorization, or similarly named document, authorizing BFBD or EGD to make certain deductions from money owed by BFBD or EGD to Customer, which Customer hereby amends to include an authorization for BFBD or EGD to withhold/collect money from Customer on behalf of the applicable Company related to the Services rendered to Customer, if any. For purposes of clarification: • Nothing in this Authorization precludes the Companies from demanding payment directly from Customer, making this Authorization permissive only. • Nothing in this Authorization requires Customer to utilize Services from any of the three Companies. This Authorization only applies to a Company if Customer has signed a separate document requesting, or otherwise acknowledging, Services. • By signing this Authorization, Customer acknowledges that BFBD or EGD may, among other things, withhold amounts Customer owes for Services from money BFBD or EGD may owe to Customer, and then forward such money to the Companies to be credited to Customer’s account with Company. Weekly settlement fees are $32/week for Corporations and $24/week for Sole Proprietors.HiddenBimbo AOR Drop files here or Select files Max. file size: 128 MB. Please note that depending on your Closing Date, time of sign up and tax return status, back fees may apply.POR FAVOR INDIQUE SI QUISIERA UN REPRESENTANTE QUE HABLE ESPAÑOL Representante que hable español preferido. reCAPTCHANameThis field is for validation purposes and should be left unchanged.
