FTI - W9 From

Form W9

Request for Taxpayer Identification Number and Certification
General Instructions
Vendors and qualfied Independant Contractors, will need to submit the following prior to receiving payment.
- Completed and submitted W9 Form below.
- Invoices for every project or period of service must be submitted. Please includie dates of service and description of work or services provided.
- Invoices should be submitted to bookkeeper@picomesivta.org.
If you have any questions or require additional information, please contact bookkeeper@picomesivta.org or 310-341-0186 x 1.

Please complete and submit the W9 Form below
Individual/Business Information
1. Name as shown on your income tax return*
2. Business/Entity name, if different from above
3. Check appropriate box for federal tax classification of the person whose name is entered on line 1.*

Individual/sole proprietor or single-member LLCC CorporationS CorporationPartnershipTrust/estateLimited liability company.Other
If you selected "Limited liability company", enter the tax classification (C=C corporation, S=S corporation, P=Partnership)*
4. Exemptions(codes apply only to certain entities, not individuals; see instructions on page 3):
Exempt Payee Code(if any)
Exemption from FATCA reporting code(if any)
5. Address*

Number, Street, and Apt. or Suite No.

Street Address Line 2

CityState

Zip Code
Part I - Taxpayer Identification Number (TIN)
Will you be using a Social Security Number or Employer Identification Number?*

Social Security NumberEmployer Identification Number
Social Security Number*
Employer Identification Number*
Part II - Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Signature*

Clear
Date*

MonthDayYear
Date
Email Address*
example@example.com
Additional Details
Please see details and general instructions below:
Payment Information
Would you like to be paid via Direct Deposit or check?*

Direct DepositCheck
Name on Bank Account*
Routing Number*
Account Number*
Account Type:*

CheckingSavings
Should be Empty:

Form W9

General Instructions

Individual/Business Information

Part I - Taxpayer Identification Number (TIN)

Part II - Certification

Additional Details

Payment Information