IRS Form W-9

Taxpayer name and classification

1. Name of entity/individual *

Must match the federal tax return. For a disregarded entity, enter the owner’s name here.

2. Business name / disregarded entity name (if different)

3b. Foreign partners, owners, or beneficiaries
Check only if line 3a is Partnership, Trust/estate, or LLC classified P, AND this W-9 is being provided to a partnership, trust, or estate in which you have an ownership interest, and you have foreign partners, owners, or beneficiaries.

4. Exempt payee code (if any)4. FATCA exemption code (if any)

Part I — Taxpayer Identification Number (TIN)

Provide the TIN corresponding to the name on line 1. For single-member disregarded LLCs, use the owner’s appropriate TIN, not necessarily the LLC’s EIN.

TIN type *Taxpayer ID *

Numbers only. The ID is masked and must be encrypted by the server.

Do not email or store the full SSN/EIN in a receipt, web analytics, URL, browser storage, or access logs. A secure server-side system is required.

Part II — Certification and signature

Under penalties of perjury, I certify that:

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
I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) 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 (c) the IRS has notified me that I am no longer subject to backup withholding; and
I am a U.S. citizen or other U.S. person (defined in the IRS instructions); and
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

I have been notified by the IRS that I am currently subject to backup withholding because I failed to report all interest and dividends. Cross out certification item 2.

Certification instructions: Item 2 must be crossed out if the IRS has notified you that you are currently subject to backup withholding for failure to report interest or dividends. Refer to the attached IRS instructions if you are unsure.

Signature method *Signature date Type your full legal signature *

I have read the certification and adopt the electronic signature above as my signature on this W-9. *

IRS Form W-9 and instructions

Broker identification

Taxpayer name and classification

Mailing address and account

Part I — Taxpayer Identification Number (TIN)

Part II — Certification and signature