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Submission: On December 15 via manual from US — Scanned from US
Submission: On December 15 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: form_243404156706150 — POST https://submit.jotform.com/submit/243404156706150
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://submit.jotform.com/submit/243404156706150" method="post" name="form_243404156706150" id="243404156706150"
accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="243404156706150"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1734216437917=>init-started:1734277983496=>validator-called:1734277983589=>validator-mounted-false:1734277983590=>init-complete:1734277983594"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1734216437917"><input type="hidden" name="uploadServerUrl" value="https://upload.jotform.com/upload"><input type="hidden"
name="eventObserver" value="1">
<div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center">
<div class="form-page-cover-image-wrapper" style="max-width:752px"><img src="https://www.jotform.com/uploads/Soccer_Motiv8/form_files/logo%20010320.67531b19ccf8d7.40554410.PNG" class="form-page-cover-image" width="280" height="138"
alt="W9 Form Logo" style="aspect-ratio:280/138"></div>
</div>
<div role="main" class="form-all">
<ul class="form-section page-section" role="presentation">
<li id="cid_2" class="form-input-wide" data-type="control_head" data-css-selector="id_2">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_2" class="form-header" data-component="header">Request for Taxpayer Identification Number and Certification</h1>
<div id="subHeader_2" class="form-subHeader">Go to www.irs.gov/FormW9 for instructions and the latest information.</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_4" data-css-selector="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4" aria-hidden="false"> 1. Name of entity/individual. An entry is required.
(For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregardedentity’s name on line 2.) </label>
<div id="cid_4" class="form-input-wide" data-layout="half"> <input type="text" id="input_4" name="q4_1Name4" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" data-component="textbox"
aria-labelledby="label_4" value=""> </div>
</li>
<li id="cid_119" class="form-input-wide" data-type="control_head" data-css-selector="id_119">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_119" class="form-header" data-component="header">OR</h2>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_5" data-css-selector="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5" aria-hidden="false"> 2. Business name/disregarded entity name, if different
from above. </label>
<div id="cid_5" class="form-input-wide" data-layout="half"> <input type="text" id="input_5" name="q5_2Business5" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" data-component="textbox"
aria-labelledby="label_5" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_checkbox" id="id_6" data-css-selector="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" aria-hidden="false"> 3. Check the appropriate box for federal tax
classification of the entity/individual whose name is entered on line 1. Checkonly one of the following seven boxes.<span class="form-required">*</span> </label>
<div id="cid_6" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_6" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_0" name="q6_3Check6[]" required="" value="Individual/sole proprietor"><label id="label_input_6_0" for="input_6_0">Individual/sole proprietor</label></span><span
class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_1" name="q6_3Check6[]" required=""
value="C Corporation"><label id="label_input_6_1" for="input_6_1">C Corporation</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_2" name="q6_3Check6[]" required="" value="S Corporation"><label id="label_input_6_2" for="input_6_2">S Corporation</label></span><span class="form-checkbox-item"
style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_3" name="q6_3Check6[]" required="" value="Partnership"><label
id="label_input_6_3" for="input_6_3">Partnership</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_4" name="q6_3Check6[]" required="" value="Trust/estate"><label id="label_input_6_4" for="input_6_4">Trust/estate</label></span><span class="form-checkbox-item"
style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_5" name="q6_3Check6[]" required=""
value="Limited liability company (additional information needed see below)."><label id="label_input_6_5" for="input_6_5">Limited liability company (additional information needed see below).</label></span><span
class="form-checkbox-item formCheckboxOther" style="clear:left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[required]" name="q6_3Check6[other]" id="other_6" tabindex="0" aria-label="Other"
value="other"><label id="label_other_6" style="text-indent:0" for="other_6">Other</label><span id="other_6_input" class="other-input-container is-none" style=""><input type="text" class="form-checkbox-other-input form-textbox"
name="q6_3Check6[other]" data-otherhint="Other" size="15" id="input_6" data-placeholder="Please type another option here" placeholder="Please type another option here"></span></span></div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_9" data-css-selector="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9" aria-hidden="false"> If you selected "Limited liability company", enter the
tax classification (C=C corporation, S=S corporation, P=Partnership) </label>
<div id="cid_9" class="form-input-wide" data-layout="half"> <input type="text" id="input_9" name="q9_ifYou" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" maxlength="1"
data-component="textbox" aria-labelledby="label_9" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_email" id="id_122" data-css-selector="id_122"><label class="form-label form-label-top form-label-auto" id="label_122" for="input_122" aria-hidden="false"> 4. Your business email address<span
class="form-required">*</span> </label>
<div id="cid_122" class="form-input-wide jf-required" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_122" name="q122_4Your" class="form-textbox validate[required, Email]"
data-defaultvalue="" autocomplete="section-input_122 email" style="width:310px" size="310" data-component="email" aria-labelledby="label_122 sublabel_input_122" required="" value=""><label class="form-sub-label" for="input_122"
id="sublabel_input_122" style="min-height:13px">example@example.com</label></span> </div>
</li>
<li class="form-line" data-type="control_address" id="id_73" data-css-selector="id_73"><label class="form-label form-label-top form-label-auto" id="label_73" for="input_73_addr_line1" aria-hidden="false"> 5-6. Your Address (number, street, and
apt. or suite no.) </label>
<div id="cid_73" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_73_addr_line1" name="q73_56Your[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_73 address-line1" data-component="address_line_1"
aria-labelledby="label_73 sublabel_73_addr_line1" value="" maxlength="100"><label class="form-sub-label" for="input_73_addr_line1" id="sublabel_73_addr_line1" style="min-height:13px">Number, Street, and Apt. or Suite
No.</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_73_addr_line2" name="q73_56Your[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_73 off" data-component="address_line_2"
aria-labelledby="label_73 sublabel_73_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_73_addr_line2" id="sublabel_73_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_73_city" name="q73_56Your[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="section-input_73 address-level2" data-component="city" aria-labelledby="label_73 sublabel_73_city" value=""
maxlength="60"><label class="form-sub-label" for="input_73_city" id="sublabel_73_city" style="min-height:13px">City</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField "><span
class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_73_state" name="q73_56Your[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="section-input_73 address-level1"
data-component="state" aria-labelledby="label_73 sublabel_73_state" value="" maxlength="60"><label class="form-sub-label" for="input_73_state" id="sublabel_73_state" style="min-height:13px">State</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_73_postal" name="q73_56Your[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_73 postal-code" data-component="zip" aria-labelledby="label_73 sublabel_73_postal" value=""
maxlength="20"><label class="form-sub-label" for="input_73_postal" id="sublabel_73_postal" style="min-height:13px">Zip Code</label></span></span></div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_121" data-css-selector="id_121"><label class="form-label form-label-top form-label-auto" id="label_121" for="input_121" aria-hidden="false"> Requester's Business Name<span
class="form-required">*</span> </label>
<div id="cid_121" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_121" name="q121_requestersBusiness" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue=""
style="width:310px" size="310" data-component="textbox" aria-labelledby="label_121" required="" value=""> </div>
</li>
<li id="cid_20" class="form-input-wide" data-type="control_head" data-css-selector="id_20">
<div class="form-header-group header-small">
<div class="header-text httal htvam">
<h3 id="header_20" class="form-header" data-component="header">Part I - Taxpayer Identification Number (TIN)</h3>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_23" data-css-selector="id_23">
<div id="cid_23" class="form-input-wide" data-layout="full">
<div id="text_23" class="form-html" data-component="text" tabindex="-1">
<p>Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole
proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.</p>
<p><span style="font-weight:bold;color:#000000;">Note: </span><span style="color:#000000;">If the account is in more than one name, see the instructions for line 1. Also see </span><span style="color:#000000;">What Name and </span> <span
style="color:#000000;">Number To Give the Requester </span><span style="color:#000000;">for guidelines on whose number to enter.</span></p>
</div>
</div>
</li>
<li id="cid_107" class="form-input-wide" data-type="control_head" data-css-selector="id_107">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_107" class="form-header" data-component="header">Social Security Number</h2>
</div>
</div>
</li>
<li class="form-line fixed-width form-line-column form-col-1" data-type="control_number" id="id_109" data-css-selector="id_109"><label class="form-label form-label-top" id="label_109" for="input_109" aria-hidden="true"> </label>
<div id="cid_109" class="form-input-wide" data-layout="half"> <input type="number" id="input_109" name="q109_x109" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_109" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-2" data-type="control_number" id="id_110" data-css-selector="id_110"><label class="form-label form-label-top" id="label_110" for="input_110" aria-hidden="true"> </label>
<div id="cid_110" class="form-input-wide" data-layout="half"> <input type="number" id="input_110" name="q110_x110" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_110" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-3" data-type="control_number" id="id_111" data-css-selector="id_111"><label class="form-label form-label-top" id="label_111" for="input_111" aria-hidden="true"> </label>
<div id="cid_111" class="form-input-wide" data-layout="half"> <input type="number" id="input_111" name="q111_x111" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_111" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-4" data-type="control_number" id="id_112" data-css-selector="id_112"><label class="form-label form-label-top" id="label_112" for="input_112" aria-hidden="true"> </label>
<div id="cid_112" class="form-input-wide" data-layout="half"> <input type="number" id="input_112" name="q112_x112" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_112" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-5" data-type="control_number" id="id_113" data-css-selector="id_113"><label class="form-label form-label-top" id="label_113" for="input_113" aria-hidden="true"> </label>
<div id="cid_113" class="form-input-wide" data-layout="half"> <input type="number" id="input_113" name="q113_x113" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_113" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-6" data-type="control_number" id="id_114" data-css-selector="id_114"><label class="form-label form-label-top" id="label_114" for="input_114" aria-hidden="true"> </label>
<div id="cid_114" class="form-input-wide" data-layout="half"> <input type="number" id="input_114" name="q114_x114" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_114" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-7" data-type="control_number" id="id_115" data-css-selector="id_115"><label class="form-label form-label-top" id="label_115" for="input_115" aria-hidden="true"> </label>
<div id="cid_115" class="form-input-wide" data-layout="half"> <input type="number" id="input_115" name="q115_x115" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_115" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-8" data-type="control_number" id="id_116" data-css-selector="id_116"><label class="form-label form-label-top" id="label_116" for="input_116" aria-hidden="true"> </label>
<div id="cid_116" class="form-input-wide" data-layout="half"> <input type="number" id="input_116" name="q116_x116" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_116" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-9" data-type="control_number" id="id_117" data-css-selector="id_117"><label class="form-label form-label-top" id="label_117" for="input_117" aria-hidden="true"> </label>
<div id="cid_117" class="form-input-wide" data-layout="half"> <input type="number" id="input_117" name="q117_x117" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30"
placeholder="_" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_117" step="any" value=""> </div>
</li>
<li id="cid_118" class="form-input-wide" data-type="control_head" data-css-selector="id_118">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_118" class="form-header" data-component="header">OR</h2>
</div>
</div>
</li>
<li id="cid_93" class="form-input-wide" data-type="control_head" data-css-selector="id_93">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_93" class="form-header" data-component="header">Employer identification number</h2>
</div>
</div>
</li>
<li class="form-line fixed-width form-line-column form-col-10" data-type="control_number" id="id_94" data-css-selector="id_94"><label class="form-label form-label-top" id="label_94" for="input_94" aria-hidden="false"> X </label>
<div id="cid_94" class="form-input-wide" data-layout="half"> <input type="number" id="input_94" name="q94_x" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30" placeholder="_"
data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_94" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-11" data-type="control_number" id="id_95" data-css-selector="id_95"><label class="form-label form-label-top" id="label_95" for="input_95" aria-hidden="false"> X </label>
<div id="cid_95" class="form-input-wide" data-layout="half"> <input type="number" id="input_95" name="q95_x95" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30" placeholder="_"
data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_95" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-12" data-type="control_number" id="id_96" data-css-selector="id_96"><label class="form-label form-label-top" id="label_96" for="input_96" aria-hidden="false"> - </label>
<div id="cid_96" class="form-input-wide" data-layout="half"> <input type="number" id="input_96" name="q96_input96" data-type="input-number" class="form-readonly form-number-input form-textbox" data-defaultvalue="" style="width:30px"
size="30" tabindex="-1" placeholder="-" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_96" readonly="" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-13" data-type="control_number" id="id_97" data-css-selector="id_97"><label class="form-label form-label-top" id="label_97" for="input_97" aria-hidden="false"> X </label>
<div id="cid_97" class="form-input-wide" data-layout="half"> <input type="number" id="input_97" name="q97_x97" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30" placeholder="_"
data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_97" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-14" data-type="control_number" id="id_98" data-css-selector="id_98"><label class="form-label form-label-top" id="label_98" for="input_98" aria-hidden="false"> X </label>
<div id="cid_98" class="form-input-wide" data-layout="half"> <input type="number" id="input_98" name="q98_x98" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30" placeholder="_"
data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_98" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-15" data-type="control_number" id="id_99" data-css-selector="id_99"><label class="form-label form-label-top" id="label_99" for="input_99" aria-hidden="false"> X </label>
<div id="cid_99" class="form-input-wide" data-layout="half"> <input type="number" id="input_99" name="q99_x99" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" style="width:30px" size="30" placeholder="_"
data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_99" step="any" value=""> </div>
</li>
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<h3 id="header_27" class="form-header" data-component="header">Part II - Certification</h3>
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<p><span style="color:#000000;">Under penalties of perjury, I certify that:</span></p>
<p><span style="color:#000000;">1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and</span></p>
<p><span style="color:#000000;">2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue </span> <span style="color:#000000;">Service (IRS) that I
am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am </span> <span style="color:#000000;">no longer subject to backup withholding; and</span></p>
<p><span style="color:#000000;">3</span><span style="color:#000000;">. I am a U.S. citizen or other U.S. person (defined below); and</span></p>
<p><span style="color:#000000;">4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.</span></p>
<p><span style="font-weight:bold;color:#000000;">Certification instructions. </span><span style="color:#000000;">You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup</span> <span
style="color:#000000;">withholding because </span> <span style="color:#000000;">you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.</span> <span
style="color:#000000;">For mortgage interest paid, </span> <span style="color:#000000;">acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement</span> <span
style="color:#000000;">arrangement (IRA), and generally, payments </span> <span style="color:#000000;">other than interest and dividends, you are not required to sign the certification, but you must</span> <span
style="color:#000000;">provide your correct TIN. See the instructions for Part II, later.</span></p>
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</form>Text Content
* REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION Go to www.irs.gov/FormW9 for instructions and the latest information. * 1. Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregardedentity’s name on line 2.) * OR * 2. Business name/disregarded entity name, if different from above. * 3. Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Checkonly one of the following seven boxes.* Individual/sole proprietorC CorporationS CorporationPartnershipTrust/estateLimited liability company (additional information needed see below).Other * If you selected "Limited liability company", enter the tax classification (C=C corporation, S=S corporation, P=Partnership) * 4. Your business email address* example@example.com * 5-6. Your Address (number, street, and apt. or suite no.) Number, Street, and Apt. or Suite No. Street Address Line 2 CityState Zip Code * Requester's Business Name* * PART I - TAXPAYER IDENTIFICATION NUMBER (TIN) * Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. * SOCIAL SECURITY NUMBER * * * * * * * * * * OR * EMPLOYER IDENTIFICATION NUMBER * X * X * - * X * X * X * X * X * X * X * PART II - CERTIFICATION * Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. 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 above 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. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. * Signature Clear * Date -Month -DayYear Date * You can check out the details and general instructions below: * Preview PDF Submit * Should be Empty: December‹› 2024«» December 2024TodaySMTWTFS12345678910111213141516171819202122232425262728293031123456789101112131415161718 Back to Form W9 Form