Request for Taxpayer Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest information.
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 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.
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
City
State
Zip Code
Social Security Number
A
A
A
G
G
S
S
S
S
or Employer identification Number
X
X
X
X
X
X
X
X
X
Signature
Date
-
Month
-
Day
Year
Date
Government ID
You can check out the details and general instructions below:
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