Form W-9 — Request for Taxpayer Identification Number and Certification

Payroll & tax

Form W-9 — Request for Taxpayer Identification Number and Certification

1 & 2. Name

Give this form to the requester. Do not send it to the IRS.

Name (as shown on your income tax return) Name is required on this line; do not leave it blank.

Business name / disregarded entity name, if different from above

3. Federal tax classification

Check the appropriate box for federal tax classification — only one of the seven.

LLC tax classificationC = C corporation, S = S corporation, P = partnership. For a single-member LLC that is disregarded, do not choose LLC above — choose the classification of the single-member owner instead.

Other classification

4. Exemptions

Codes apply only to certain entities, not individuals. See the instructions on page 3 of the form.

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)Applies to accounts maintained outside the U.S.

5 to 7. Address and account numbers

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester's name and address (optional)

List account number(s) here (optional)

Part I. Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate boxes. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals this is generally your social security number; for other entities it is your employer identification number.

Enter either a social security number or an employer identification number — not both. If you would rather not enter a taxpayer number online, leave these boxes blank and write it on the printed form before signing.

SSN — first three digits

SSN — middle two

SSN — last four

EIN — first two digits

EIN — remaining seven

Part II. Certification

Under penalties of perjury I certify that the number shown on this form is my correct taxpayer identification number, or that I am waiting for a number to be issued to me.

I am not subject to backup withholding because: I am exempt from backup withholding; or I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends; or the IRS has notified me that I am no longer subject to backup withholding.

I am a U.S. citizen or other U.S. person.

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 on the printed form 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. The signature and date lines are left blank for you to complete by hand.