DESCO Dental Customer Account Information
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  • Customer Account Information

  • DESCO Dental Service
    PO Box 6787
    Providence RI 02940
    Phone: 508-520-0040
    DESCO Dental Service - DESCO Fax: 508-520-7055

  • You must fill out all required fields with a red asterisk in this form and in the W9.

  • Office Billing Information

  • For billing questions and additional credit-related information, with whom should DESCO contact?

  • Format: (000) 000-0000.
  • Are you Tax Exempt?
  • Important: if yes, a state exemption certificate must be supplied for the state where the service is performed, or the product(s) are shipped. Failure to submit the tax-exempt certificate will result in tax being charged.
  • Are you requesting credit card terms only?

  • Physical Office Address

  • Format: (000) 000-0000.
  • We look forward to working with you!
  • Providing service for over 55 years!
  • DESCO Corporate Headquarters
    200 Venture Way
    Hadley, MA 01035
    Telephone: 800-845-0606
  • DESCO Southeast Regional Office
    8109 NW 33 Street
    Doral, FL 33122
    Telephone: 877.845.5911

  • Form W-9

  • (Rev. March 2024)
    Department of the Treasury
    Internal Revenue Service

  • Request for TaxpayerIdentification Number and Certification

  • Before you begin. For guidance related to the purpose of Form W-9, go to www.irs.gov/FormW9 for instructions and the latest information.

  • 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.
  • Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.
  • (Applies to accounts maintained outside the United States.)

  • 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.
  • Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

  • 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.
  • Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
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