Form
W-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer Identification Number and Certification
*Canvassers - Only fill out as an Individual, not a business/LLC with an EIN*
1 Name (as shown on your income tax return).
*
2 Business name/disregarded entity name, if different from above
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 LLC
C Corporation
S Corporation
Partnership
Trust/estate
Limited liability company
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
5 Address (number, street, and apt. or suite no.)
*
6 City
*
State
*
Zip Code
*
Email
*
example@example.com
Part I Taxpayer Identification Number (TIN)
Social security number OR Employer identification number
Social security number
*
Employer identification number
Part II Certification
Signature of U.S. Person
*
Date
*
-
Month
-
Day
Year
Date
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Drivers License
*
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*
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