Form W-9: Request for Taxpayer Identification Number and Certification

Rev. March 2024 | Department of the Treasury — Internal Revenue Service

Give form to the requester. Do not send to the IRS.

Line 1 — Name (as shown on your income tax return) *

Line 2 — Business name / disregarded entity name (if different from above)

Line 3a — Federal Tax Classification

Check the appropriate box for the federal tax classification of the entity/individual whose name is entered on line 1. Check only one.

Federal Tax Classification *

Individual / sole proprietor or single-member LLC C corporation S corporation Partnership Trust / estate LLC — C corporation LLC — S corporation LLC — Partnership Other (see instructions)

Line 3b — Foreign Partners / Owners / Beneficiaries

If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries.

Foreign Partners, Owners, or Beneficiaries

Yes — I have foreign partners, owners, or beneficiaries No — I do not have foreign partners, owners, or beneficiaries

Line 4 — Exemptions

Codes apply only to certain entities, not individuals. See instructions on page 3.

Exempt Payee Code (if any)

Exemption from FATCA Reporting Code (if any)

Address

Line 5 — Street Address (number, street, and apt. or suite no.) *

Line 6 — City, State, and ZIP Code *

Requester's Name and Address (optional)

Line 7 — List Account Number(s) Here (optional)

Part I — Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your Social Security Number (SSN). For other entities, it is your Employer Identification Number (EIN).

Social Security Number (SSN)

Employer Identification Number (EIN)

Part II — 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; and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Signature of U.S. Person *

Date *

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