Form W-9 Request for Taxpayer Give form to the
(Rev. January 2002) requester. Do not
Department of the Treasury
Identification Number and Certification send to the IRS.
Internal Revenue Service
See Specific Instructions on page 2.
Business name, if different from above
Print or type
Individual/ Exempt from backup
Check appropriate box: Sole proprietor Corporation Partnership Other withholding
Address (number, street, and apt. or suite no.) Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security number
However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on – –
page 2. For other entities, it is your employer identification number (EIN). If you do not have a number,
see How to get a TIN on page 2. or
Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number Employer identification number
to enter. –
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. person (including a U.S. resident alien).
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 on page 2.)
Sign Signature of
Here U.S. person Date
Purpose of Form What is backup withholding? Persons making 5. You do not certify to the requester that you
certain payments to you must under certain are not subject to backup withholding under 4
A person who is required to file an information conditions withhold and pay to the IRS 30% of above (for reportable interest and dividend
return with the IRS must get your correct such payments after December 31, 2001 (29% accounts opened after 1983 only).
taxpayer identification number (TIN) to report, for after December 31, 2003). This is called “backup
example, income paid to you, real estate Certain payees and payments are exempt
withholding.” Payments that may be subject to from backup withholding. See the instructions on
transactions, mortgage interest you paid, backup withholding include interest, dividends,
acquisition or abandonment of secured property, page 2 and the separate Instructions for the
broker and barter exchange transactions, rents, Requester of Form W-9.
cancellation of debt, or contributions you made royalties, nonemployee pay, and certain
to an IRA. payments from fishing boat operators. Real Penalties
Use Form W-9 only if you are a U.S. person estate transactions are not subject to backup
(including a resident alien), to give your correct withholding. Failure to furnish TIN. If you fail to furnish your
TIN to the person requesting it (the requester) correct TIN to a requester, you are subject to a
You will not be subject to backup withholding penalty of $50 for each such failure unless your
and, when applicable, to: on payments you receive if you give the failure is due to reasonable cause and not to
1. Certify the TIN you are giving is correct (or requester your correct TIN, make the proper willful neglect.
you are waiting for a number to be issued), certifications, and report all your taxable interest
and dividends on your tax return. Civil penalty for false information with respect
2. Certify you are not subject to backup to withholding. If you make a false statement
withholding, or Payments you receive will be subject to with no reasonable basis that results in no
backup withholding if: backup withholding, you are subject to a $500
3. Claim exemption from backup withholding if
you are a U.S. exempt payee. 1. You do not furnish your TIN to the penalty.
requester, or Criminal penalty for falsifying information.
If you are a foreign person, use the
appropriate Form W-8. See Pub. 515, 2. You do not certify your TIN when required Willfully falsifying certifications or affirmations
Withholding of Tax on Nonresident Aliens and (see the Part II instructions on page 2 for may subject you to criminal penalties including
Foreign Entities. details), or fines and/or imprisonment.
3. The IRS tells the requester that you Misuse of TINs. If the requester discloses or
Note: If a requester gives you a form other than
furnished an incorrect TIN, or uses TINs in violation of Federal law, the
Form W-9 to request your TIN, you must use the
requester may be subject to civil and criminal
requester’s form if it is substantially similar to this 4. The IRS tells you that you are subject to penalties.
Form W-9. backup withholding because you did not report
all your interest and dividends on your tax return
(for reportable interest and dividends only), or
Cat. No. 10231X Form W-9 (Rev. 1-2002)
Form W-9 (Rev. 1-2002) Page 2
Application for IRS Individual Taxpayer Privacy Act Notice
Specific Instructions Identification Number, to apply for an ITIN, or
Name. If you are an individual, you must Form SS-4, Application for Employer Section 6109 of the Internal Revenue Code
generally enter the name shown on your Identification Number, to apply for an EIN. requires you to give your correct TIN to
social security card. However, if you have You can get Forms W-7 and SS-4 from the persons who must file information returns
changed your last name, for instance, due to IRS by calling 1-800-TAX-FORM with the IRS to report interest, dividends, and
marriage without informing the Social Security (1-800-829-3676) or from the IRS Web Site at certain other income paid to you, mortgage
Administration of the name change, enter www.irs.gov. interest you paid, the acquisition or
your first name, the last name shown on your abandonment of secured property,
If you are asked to complete Form W-9 but cancellation of debt, or contributions you
social security card, and your new last name. do not have a TIN, write “Applied For” in the made to an IRA or Archer MSA. The IRS uses
If the account is in joint names, list first and space for the TIN, sign and date the form, the numbers for identification purposes and
then circle the name of the person or entity and give it to the requester. For interest and to help verify the accuracy of your tax return.
whose number you enter in Part I of the form. dividend payments, and certain payments The IRS may also provide this information to
Sole proprietor. Enter your individual made with respect to readily tradable the Department of Justice for civil and
name as shown on your social security card instruments, generally you will have 60 days criminal litigation, and to cities, states, and
on the “Name” line. You may enter your to get a TIN and give it to the requester the District of Columbia to carry out their tax
business, trade, or “doing business as (DBA)” before you are subject to backup withholding laws.
name on the “Business name” line. on payments. The 60-day rule does not apply
to other types of payments. You will be You must provide your TIN whether or not
Limited liability company (LLC). If you are you are required to file a tax return. Payers
a single-member LLC (including a foreign LLC subject to backup withholding on all such
payments until you provide your TIN to the must generally withhold 30% of taxable
with a domestic owner) that is disregarded as interest, dividend, and certain other payments
an entity separate from its owner under requester.
to a payee who does not give a TIN to a
Treasury regulations section 301.7701-3, Note: Writing “Applied For” means that you payer. Certain penalties may also apply.
enter the owner’s name on the “Name” have already applied for a TIN or that you
intend to apply for one soon.
line. Enter the LLC’s name on the “Business
name” line. Caution: A disregarded domestic entity that
What Name and Number To
Other entities. Enter your business name has a foreign owner must use the appropriate Give the Requester
as shown on required Federal tax documents Form W-8.
For this type of account: Give name and SSN of:
on the “Name” line. This name should match
the name shown on the charter or other legal Part II—Certification 1. Individual The individual
document creating the entity. You may enter To establish to the withholding agent that you 2. Two or more The actual owner of the
any business, trade, or DBA name on the are a U.S. person, or resident alien, sign Form individuals (joint account or, if combined
“Business name” line. W-9. You may be requested to sign by the account) funds, the first individual
on the account 1
Exempt from backup withholding. If you withholding agent even if items 1, 3, and 5
3. Custodian account of The minor 2
are exempt, enter your name as described below indicate otherwise. a minor (Uniform Gift
above, then check the “Exempt from backup For a joint account, only the person whose to Minors Act)
withholding” box in the line following the TIN is shown in Part I should sign (when 4. a. The usual The grantor-trustee 1
business name, sign and date the form. required). Exempt recipients, see Exempt revocable savings
from backup withholding above. trust (grantor is
Individuals (including sole proprietors) are also trustee)
not exempt from backup withholding. Signature requirements. Complete the b. So-called trust The actual owner 1
Corporations are exempt from backup certification as indicated in 1 through 5 account that is not
withholding for certain payments, such as below. a legal or valid trust
interest and dividends. For more information 1. Interest, dividend, and barter under state law
on exempt payees, see the Instructions for exchange accounts opened before 1984 5. Sole proprietorship The owner 3
the Requester of Form W-9. and broker accounts considered active
If you are a nonresident alien or a foreign during 1983. You must give your correct TIN, For this type of account: Give name and EIN of:
entity not subject to backup withholding, give but you do not have to sign the certification. 6. Sole proprietorship The owner 3
the requester the appropriate completed 2. Interest, dividend, broker, and barter 7. A valid trust, estate, or Legal entity 4
Form W-8. exchange accounts opened after 1983 and pension trust
Note: If you are exempt from backup broker accounts considered inactive during 8. Corporate The corporation
withholding, you should still complete this 1983. You must sign the certification or 9. Association, club, The organization
form to avoid possible erroneous backup backup withholding will apply. If you are religious, charitable,
educational, or other
withholding. subject to backup withholding and you are tax-exempt
merely providing your correct TIN to the organization
Part I—Taxpayer Identification requester, you must cross out item 2 in the 10. Partnership The partnership
Number (TIN) certification before signing the form. 11. A broker or registered The broker or nominee
Enter your TIN in the appropriate box. 3. Real estate transactions. You must nominee
sign the certification. You may cross out 12. Account with the The public entity
If you are a resident alien and you do not Department of
have and are not eligible to get an SSN, your item 2 of the certification.
Agriculture in the name
TIN is your IRS individual taxpayer 4. Other payments. You must give your of a public entity (such
identification number (ITIN). Enter it in the correct TIN, but you do not have to sign the as a state or local
social security number box. If you do not certification unless you have been notified government, school
district, or prison) that
have an ITIN, see How to get a TIN below. that you have previously given an incorrect receives agricultural
If you are a sole proprietor and you have TIN. “Other payments” include payments program payments
an EIN, you may enter either your SSN or made in the course of the requester’s trade
EIN. However, the IRS prefers that you use or business for rents, royalties, goods (other 1
List first and circle the name of the person whose
your SSN. than bills for merchandise), medical and number you furnish. If only one person on a joint
health care services (including payments to account has an SSN, that person’s number must be
If you are an LLC that is disregarded as
corporations), payments to a nonemployee for furnished.
an entity separate from its owner (see
services, payments to certain fishing boat 2
Limited liability company (LLC) above), and Circle the minor’s name and furnish the minor’s SSN.
crew members and fishermen, and gross
are owned by an individual, enter your SSN 3
You must show your individual name, but you may
proceeds paid to attorneys (including
(or “pre-LLC” EIN, if desired). If the owner of also enter your business or “DBA” name. You may use
payments to corporations).
a disregarded LLC is a corporation, either your SSN or EIN (if you have one).
partnership, etc., enter the owner’s EIN. 5. Mortgage interest paid by you, 4
List first and circle the name of the legal trust, estate,
acquisition or abandonment of secured or pension trust. (Do not furnish the TIN of the personal
Note: See the chart on this page for further
property, cancellation of debt, qualified representative or trustee unless the legal entity itself is
clarification of name and TIN combinations.
tuition program payments (under section not designated in the account title.)
How to get a TIN. If you do not have a TIN, 529), IRA or Archer MSA contributions or
apply for one immediately. To apply for an Note: If no name is circled when more than
distributions, and pension distributions. one name is listed, the number will be
SSN, get Form SS-5, Application for a Social You must give your correct TIN, but you do
Security Card, from your local Social Security considered to be that of the first name listed.
not have to sign the certification.
Administration office. Get Form W-7,