FORM W-9

Request for Taxpayer Identification Number and Certification

Instructions

Give Form W-9 to the requester. You must provide your correct taxpayer identification number (TIN) to avoid backup withholding.

For federal tax purposes, you are considered a person if you are an individual, corporation, partnership, etc.

PART 1: NAME AND BUSINESS INFORMATION

PART 2: FEDERAL TAX CLASSIFICATION

Check the appropriate box for federal tax classification (check only one):

PART 3: ADDRESS

PART 4: TAXPAYER IDENTIFICATION NUMBER (TIN)

Enter your TIN in the appropriate box. For individuals, this is generally your social security number (SSN). For business entities, this is your employer identification number (EIN).

OR

PART 5: 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 in the instructions); 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.

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