REQUEST FOR TAXPAYER INDENTIFICATION (W-9)
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
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2 Business name/disregarded entity name, if different from above
Individual/sole proprietor or single member LLC
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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
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What is your partnership status?
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I am an employee.
I am a volunteer.
I am a community member.
I am a vendor/contractor.
Date
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Month
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Day
Year
Date
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