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IRS Form W-9: Request for Taxpayer Identification and Certification. click here for detailed instructions.
Full Legal Name:
Business Name:
Business Type:
Exempt Payee:
Address:
City, ST Zip:	,
Taxpayer Identification Number (TIN):
SSN	--
EIN	-
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 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 I am a U.S. citizen or other U.S. person (defined here).
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 Form.