3. REQUEST FOR TAXPAYER INDENTIFICATION (W-9)
Personnel ID:
*
What is your partnership status?
*
I am an Employee/Intern
I am a Contractor/Vendor
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have an EIN?
*
Yes
No
Enter your SSN:
*
*
*
*
*
*
*
*
*
Enter your EIN:
*
*
*
*
*
*
*
*
*
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
*
First Name
Last Name
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
*
Individual/sole proprietor or single member LLC
*
Individual/sole proprietor or single member LLC
C Corporation
Partnership
Trust/estate
S Corporation
Limited Liability Company
Limited Liability Company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Address
*
5 Address (number, street, and apt. or suite no.)
Street Address Line 2
6 City, state, and ZIP code
State / Province
Postal / Zip Code
Social Security Number
Employee Identification Number
Signature of U.S. person
*
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Submit
Should be Empty: