Stripe Government Entity Letterhead Form

Please complete this form if your organization needs to 1) fulfill ID or SSN verification requirements and/or 2) register your organization as a Government Entity with Stripe. By submitting this form, you confirm your intent to classify your business as a government entity with Stripe (if not already classified as such) and authorize Hometown to submit this request on your behalf.

What is a Government Entity? An organization that is directly controlled by or is a part of a national, state, or local government, operating with public funds to serve public interests and are subject to governmental oversight and regulations.

Note: This form is exclusively for government entities and must be completed by a business employee other than the Stripe Account Representative.

Employee Information (This is a director-level or above company signatory who is not the Stripe Account Owner/Representative, and can serve as a secondary verifier)

Employee Name*

First NameLast Name

Employee Job Title*

Principal, CFO, etc.,

Employee Email*

example@school.edu

Stripe Account Information

Stripe Account ID*

acct_123456789XYZ

Business name(s)*

Website URL(s)*

Business Tax ID*

This is the same as an EIN, which is a federal tax ID number for businesses, tax-exempt organizations and other entities.

Stripe Account Representative Name *

First NameLast Name

Stripe Account Representative Job Title*

Employee Confirmation

I, {employeeName}, {employeeJob}, authorize {stripeAccount85}, {stripeAccount}, to manage the Stripe Account.

Upon signature, I confirm that (must check all):*

I am employed at the aforementioned business entity.The information provided in this document is accurate, including the business entity name, which must exactly match the Stripe account.I authorize Hometown to facilitate this submission on my behalf.

Date ("Effective Date")*

Signature

HT Support Email

example@example.com

Stripe Support Email

example@example.com

Stripe HT Email

example@example.com

All verification decisions are made solely by Stripe. This form is provided to assist with your communication with Stripe. You are solely responsible for the accuracy of any information and for submitting it to Stripe. Hometown does not verify or guarantee the accuracy of this information.