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Form W-9

1.Name (as shown on your income tax return): * Name is required on this line; do not leave this line blank

2. Business name/disregarded entity name, if different from name in number one:

3.Select the appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or single-member LLC

C Corporation

S Corporation

Partnership

Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

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

Other (see link to IRS instructions)

4. Exemptions (codes apply only to certain entities, not individuals; see link to IRS instructions)

Exempt payee code (if any) (Applies to accounts maintained outside the U.S.)

Exemption from FATCA reporting code (if any)

5.Address (number, street, and apt. or suite no.) see link to IRS instructions *

6.City, state, and ZIP code *

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

8.Requester's name and address (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). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I in IRS instructions. For other entities, it is your employeer identification number (EIN). If you do not have a number, see How to get a TIN in Part I of IRS instructions.

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 in IRS instructions for guidelines on whose number to enter.

Social Security Number *

Employer Identification Number *

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 in IRS general W-9 instructions); and

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

Certification instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II in IRS W-9 instructions.

Click box to strike out item 2 above.

Sign Here

Signature of U.S. person By checking this box and typing my name below, I sign this form.

Date *

Please enter your name *

W-9 – Request for Information Required to Initiate Payment

W9 Form

Form W-9

Part I : Taxpayer Identification Number (TIN)

Part II : Certification

Sign Here

Bank Information

Paying By ACH

Paying By Wire: Fill in the fields appropriate for your banking situation.