Certificat holder for W9 Certificate holder 1. Full Name 2. Business name Email Date Type of industry Individual/sole proprietor or single-member LLC C Corporation SS Corporation Partnership Trust/estate Limited liability company Other Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) If other, Describe 4 Exemptions (codes apply only to certain entities, not individuals): Exempt payee code (if any) Exemption from FATCA reporting code (if any) 5. Address (number, street, and apt. or suite no.) . 6. City, state, and ZIP code 7. List account number(s) here (optional) Part I. Taxpayer Identification Number (TIN) Social security number OR Employer identification number Signature
