W-9

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

Business name/disregarded entity name, if different from above

Federal-Tax-Classification Individual

Individual/sole proprietor or single-member LLC

Federal-Tax-Classification C Corp

C Corporation

Federal-Tax-Classification S Corp

S Corporation

Federal-Tax-Classification Partnership

Partnership

Federal-Tax-Classification Trust

Trust/estate

Federal-Tax-Classification Limited

Limited liability company

Enter the tax classification

Other

See Instuctions

Exempt payee code

Exemption from FATCA reporting code

Requester-Name

Requester-Address

street_address

state

city

zip

List account number(s) here (optional)

SSN 1

SSN 2

SSN 3

EIN 1

EIN 2

Signature1

Date

Logistics (Own Authority)