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Service Provider Registration
Full Name or Company Name (as shown on tax return)
*
Primary Contact Person
*
First Name
Last Name
Preferred communication language
*
Please Select
English
Spanish
When reaching out to you, in what language do you prefer our communication?
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Full Personal or Company Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
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District of Columbia
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Louisiana
Maine
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Who is your point of contact or Account Manager at EVID?
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Preferred Payment Method
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Mailed Check (Sent to registered address)
Bank Deposit
Please provide bank name
*
Please provide bank account number
*
Please provide bank routing number
*
Bank account holder name
*
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Emergency Contact Information
Emergency Contact Full Name
*
First Name
Last Name
Relationship to Emergency Contact
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Trades and Services
What types of services do you provide?
*
Landscaping
Maintenance
Snow
Janitorial
Other
Is there any additional information about your services that you would like to provide? You may list specific services here.
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Form W-9
Do you have an already completed and signed W9 form to provide?
*
No
Yes
Upload W9 form here
*
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Request for Taxpayer Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.)
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2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.
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Individual/sole proprietor
C corporation
S corporation
Partnership
Trust/estate
LLC. Enter the tax classification below (C C corporation, S S corporation, P Partnership)
Other
LLC Tax Classification
*
Please Select
C
S
P
3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions
4 Exempt payee code (if any):
Exemption form Foreign Account Tax Compliance (FATCA) reporting code (if any)
5 Address (number, street, and apt. or suite no.).
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
6 City, state, and ZIP code
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.
Social security number
*
or
Employer identification number
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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 of U.S. person
*
Date
*
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Month
-
Day
Year
Date
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