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Request Taxpayer Identification Number Certification

Form W-9 Revised December 2017 Commonwealth of Virginia Substitute W-9 Form Request for Taxpayer Identification Number and Certification Please select the appropriate Taxpayer Identification Number (EIN or SSN) type and enter your 9 digit ID Number . The EIN or SSN provided must match the name given on the Legal Name line to avoid backup withholding. If you do not have a Tax ID Number , please reference "Specific Instructions Section 1." If the account is in more than one name, provide the name of the individual who is recognized with the IRS as the responsible party. Social security Number (SSN) Employer Identification Number (EIN) Dunn & Bradstreet Universal Numbering System (DUNS) (see instructions) Legal Name: Business Name: Entity Type Individual Sole Proprietorship Partnership Trust Estate Government Non Profit S Corporation C Corporation Disregarded Entity Partnership

Social Security Number (SSN) ... I am a U.S. citizen or other U.S. person (defined later in general instructions), and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. ... April 30, 1984) allows the provisions of Article 20 to

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