W-9 Form Submission

has requested a W-9 Form to get your TIN.

Payer (Requestor) Information

Name:

TIN:

Address:

To ensure a seamless process, please enter your details, including your TIN, review the information, electronically sign the form and Submit it. Once submitted, The Signed form will be promptly sent to

Federal tax classification of the entity/individual

*Classification Type

Name of entity/individual

Name of entity/individual.

Business name/disregarded entity name, if different from above

Trade name/DBA name

Are you exempt from backup withholding and/or FATCA reporting?

Yes

*Address Line 1

Address Line 2

*City

*State

*Zip Code

Taxpayer Identification Number (TIN)