W-9

Please provide answers below and click Submit information.

IRS Form W-9
Request for Taxpayer
Identification Number and Certification
Click here to open Form W-9 instructions
from the IRS web site in a new window.
* Required Fields

* First Name:

* Last Name:

Business name, if different from above:

* Select appropriate choice:

Individual/Sole proprietor
Corporation
Partnership
Other

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. Exempt from backup withholding
* Street Address:
Address 2:
* City:
* State, province or region:
Zip or postal code, if appropriate

* Country:

E-mail Address:

Phone:

Part 1: Taxpayer Identification Number
Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the W-9 Part I instructions on page 3 (link below). For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN in the W-9 Part I instructions on page 3 (link below).
Note: If the account is in more than one name, see the chart on page 4 of the W-9 Part II instructions (link below) for guidelines on whose number to enter.
Form W-9 with instructions.

* Social security number:

OR

* Employer identification number:

Part 2: Certification
Under penalties of perjury, I certify that:

1.	The number shown on this form is my correct taxpayer identification number, 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. person (including a U.S. resident alien).

Check here 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.

* Signature of U.S. person (Typing in your name acts as your signature):

The date and time of submission and your computer's IP address will be recorded when you
click Submit information

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