W-9 Form

Request for Taxpayer Identification Number and Certification

Choose Your Location

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 companyLimited liability company

OtherOther

If Limited Liability Company enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶ Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

4a Exemptions

4b Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

5 Address (number, street, and apt. or suite no.) See instructions. *

6 City, state, and ZIP code *

Requester’s name and address (optional)

7 List account number(s) here (optional)

Taxpayer Identification Number (TIN)

Social security number *

Employer identification number *

If you are human, leave this field blank.