Form W-9 — Request for Taxpayer Identification Number & Certification

Give this to the requester (Virtual Companion Chat). Complete all fields, download, and upload it back on your sign-up form. Required before your first payment. Do not send to the IRS.

1. NAME & BUSINESS

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

2. Business name / disregarded entity name, if different from above

3. FEDERAL TAX CLASSIFICATION — check ONE

If LLC, tax classification (C = C corp, S = S corp, P = Partnership)

Other (see IRS instructions)

Most contractors here are "Individual / sole proprietor."

ADDRESS

5. Address (number, street, and apt. or suite no.)

6. City

State

ZIP code

PART I — TAXPAYER IDENTIFICATION NUMBER (TIN)

Enter your TIN. For an individual/sole proprietor this is generally your Social Security Number (SSN). For other entities, it is your Employer Identification Number (EIN). Enter ONE.

Social Security Number (SSN)

— or — Employer ID 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 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.

Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding.

Signature of U.S. person (type your full legal name) *

Date *

By checking this box and typing my name above, I am electronically signing this Form W-9 (E-SIGN Act / UETA).

This fillable form is provided for administrative convenience and is not tax or legal advice. The official IRS Form W-9 is at irs.gov/FormW9.