Form W-9 Request for Taxpayer

Give form to therequester. Do notsend to the for TaxpayerIdentification Number and Certification(Rev. January 2003)Department of the TreasuryInternal revenue ServiceNameList account number(s) here (optional)Address (number, street, and apt. or suite no.)City, state, and ZIP codePrint or typeSee Specific Instructions on page Identification Number (TIN)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 Part I instructions onpage 3. For other entities, it is your employer identification number (EIN). If you do not have a number,see How to get a TIN on page security number orRequester s name and address (optional)Employer identification numberNote: If the account is in more than one name, see the chart on page 4 for guidelines on whose numberto enter.

Give form to the requester. Do not send to the IRS. Form W-9 Request for Taxpayer (Rev. January 2003) Identification Number and Certification Department of the Treasury Internal Revenue Service

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