legal: w9 – IABLE

Request for Taxpayer Identification Number and Certification
Rev. October 2018

1. Name (individual or company name as shown on your income tax return) *

2. Business Name/Disregarded Entity Name (if different from above)

3. Check appropriate box: *

Individual/sole proprietor or single-member LLC

C Corporation

S Corporation

Partnership

Trust/estate

Limited liability company. Enter the tax classification below - field will appear if this option is selected

Other (see instructions: http://www.irs.gov/pub/irs-pdf/fw9.pdf):Other (see instructions: http://www.irs.gov/pub/irs-pdf/fw9.pdf):

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Limited liability company tax classification (C=C corporation, S=S corporation, P=Partnership) *

4. Exemptions (codes apply only to certain entities, not individuals):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

5. Address *

Address 2

6. City *

6. State *

6. Zip Code *

Requester’s name and address (optional)

7. List account number(s) here (optional)

Part 1 Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3 (fw9.pdf). 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 3 (fw9.pdf).

Note: If the account is in more than one name, see the instructions for line 1. Also see "What Name and Number To Give the Requester" for guidelines on whose number to enter.

Social Security Number (SSN)

or 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 (defined below), and

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

By typing my name and contact email address, I confirm that I agree to the electronic submission of my completed W9 form and that I accept that the information provided constitutes a legally binding digital signature.

Signature *

Clear

Date *

Contact Email *

Confirm Contact Email *

W-9

4. Exemptions (codes apply only to certain entities, not individuals):

Part 1 Taxpayer Identification Number (TIN)

Part II Certification