Request for Taxpayer Identification Number and Certification

Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the requester. Do not send to the IRS.
1 Name as shown on your income tax return Name is required on this line; do not leave this line blank.*
2 Business name/disregarded entity name, if using EIN Number, not SSN
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)Other (see Instructions)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Identification Number (TIN)
Social security number
or
Employer Identification Number
Signature of U.S. person*
Please type your name above as signature
Date*

MonthDayYear
Date
4
Should be Empty: