Form

Form W-9: Taxpayer information

Request for Taxpayer Identification Number and Certification. This is a digital collection form, not the official IRS form.

Your details 1. Name (as shown on your income tax return) 2. Business name / disregarded entity name (if different) 3a. Federal tax classification 3b. I am a partnership, trust, or estate with foreign partners, owners, or beneficiaries

4. Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

5. Address (number, street, apt. or suite)

6. City

State

ZIP

7. Account number(s) (optional)

Part I. Taxpayer Identification Number Social security number (SSN) Employer identification number (EIN) Number

Encrypted in transit. Never share this number by email or chat.

Part II. Certification

Under penalties of perjury, I certify that:

The number shown on this form is my correct taxpayer identification number (or I am waiting for one to be issued to me).
I am not subject to backup withholding, or the IRS has told me I am no longer subject to it.
I am a U.S. citizen or other U.S. person.
Any FATCA code(s) entered on this form (if any) show that I am exempt from FATCA reporting.

The IRS has notified me that I am currently subject to backup withholding (item 2 will be crossed out) I have read and agree to the certification above. Signature (draw with finger, mouse, or stylus)

Sign inside the box

Type your full name

Date

Form submitted. Your signed W-9 information was received.