CONTINGENCY AWARDS PROGRAM OFFICAL REQUEST FORM by wmj44090

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									                                                                                           CONTINGENCY AWARDS PROGRAM
                                                                                               OFFICAL REQUEST FORM

This form must be filled out completely. One event per form, please.   W-9 Tax Form – A W-9 Tax Form must be on file for contingency
                                                                       awards to be paid. A new W-9 form must be submitted only if you
Official Race Results - A copy of the official race results must be    change your address. The Social Security or Tax ID entered on this
included. Must show drivers name, make/model of vehicle, club,         request form must match the number on the W-9 we have on file.
class, and date of event. (MyLaps results are not acceptable).
                                                                       Please allow 6-8 weeks for payment processing.
Color photo Required - Your first contingency request each year
must be accompanied by current color photos of your race car clearly
showing proper placement of Mazda and Mazdaspeed decal place-
ment.

Mazda/Mazdaspeed Logo Decal Requirement – To be eligible for           Open Wheel & Sports Racers (No kit part number)




                                                                                                                                                  Rules
Mazda Contingency Award Program the following decals must be
placed on Mazda race vehicle:                                          1. Mazda logo under brand symbol vertical logo (Winged-M) (part
                                                                       #0000-10-VM16-XX*) on front nose.
Stock/production bodywork - Order decal set K-DECL-XX-WM1*
for all required items.                                                2. Mazda logo on both sides of engine cover (16” length) (part
                                                                       number 0000-10-0016-XX*)
1. Mazda logo – 22” length decal on both rear fenders above wheel
opening (White, black, silver or blue only)                            3. Mazda Patch —5” Mazda patch required on front of driver’s suit
                                                                       (pocket area) for all classes that require a driver’s suit. (part number
2. MAZDASPEED logo -26” length decal on front nose or foremost         0000-10-PTCH-05)
part of hood (White, black, silver or blue only)
                                                                       Decals may be ordered using the Mazdaspeed website or by calling
3. Mazda Patch —5” Mazda patch required on front of driver’s suit      800-435-2508.
(pocket area) for all classes that require a driver’s suit.

        *For decals and kits above, replace XX in part number with BL for Blue, BK for Black, SL for Silver, and WH for White


                                           PLEASE FILL OUT ALL SECTIONS COMPLETELY




                                                                                                                                                  Driver Information
 Date                                           Team Support Number                           Daytime Phone


 Driver’s Name                                                                                Evening Phone


 Social Security Number                 OR      Tax ID Number


 Mailing Address


 City                                             State                  Zip                         Check here if address
                                                                                                     has changed.
 E-mail Address



 Race Event                                                                                   Event Date
                                                                                                                                                  Race Information Mail To:
 Event Location (Track)


Class                                            Model                                        Year

Finishing Position                                                                            Award Amount

 The first request of the year MUST include a completed W-9 form AND a current color photo of your race vehicle showing the proper
 placement of the required Mazda decals.

                                                          MAZDASPEED MOTORSPORTS
                                                          Attn: Contingency Requests
                                  Please mail form to:    1421 Reynolds Avenue
                                                          Irvine, CA 92614
                                                          800-435-2508
    2008 Contingency Awards Program Payout Schedule
Program Rules -
- Mazda Contingency Awards are available to competitors racing a Mazda production vehicle, Mazda based silhouette race vehicle or Mazda-
  powered open-wheel or sports racer purpose-built race vehicle.
- All payout amounts listed require a minimum number of competitors in the class. To be eligible for the amounts listed within this schedule
  competitor must finish ahead of at least two (2) other competitors in their class. If the Mazda competitor finishes ahead of only one (1) other
  driver in their class the amount listed is reduced by 25%. No award payout will be made if Mazda competitor does not finish ahead of at least
  one (1) other class competitor.
- To be eligible for year-end (championship) points payout the competitor must have raced a Mazda in every event during the season.




Claiming Contingency Award Funds -
- To be eligible for the Mazda contingency award program Mazda competitiors must be a Mazda Team Support member in good standing.
- A separate Mazda Contingency Award Request Form must be completed and submitted for each event.
- Each request form submitted must be accompanied by official (final) event results. Official race results must show the event name and date,
  driver's finishing position within class and the make/model of vehicle raced. (Note: Results from www.MyLaps.com website will not be accepted
  since they do not show the vehicle make/model information)
- A current color photograph(s) showing your race vehicle and the proper placement of Mazda and Mazdaspeed logo decals must accompany
  with your first contingency request each season.
- A W-9 Tax Form must be on file for a contingency request to be processed and paid. If you submitted a W-9 Tax Form in 2007 you do not need
 to resubmit another form unless your address has changed. A W-9 Tax Form can be downloaded along with the Mazda Contingency Request
 Form at www.MazdaMotorsports.com under the Contingency Info tab on the front page.
- Contingency Request Forms, race results and photos must be mailed to the address on the request form. Faxed copies will not be accepted.

       Mazda reserves the right to change, modify or cancel any contingency award payouts listed.
Club Racing
SCCA NATIONAL CLUB RACING
GT                    GT1, GT2, GT3 & GTL          SPORTS RACER                              CSR & DSR          FORMULA MAZDA
1st Place                              $500        1st Place                                          $500      No contingency payout is available per event;
2nd Place                              $300        2nd Place                                          $300      payout is available for SCCA Runoffs and
3rd Place                              $150        3rd Place                                          $150      June Sprints. No tow fund is available for
Divisional                                         Divisional                                                   Runoffs.
Championship                         $1,000        Championship                                    $1,000       Divisional
                                                                                                                Championship                             $500

PRODUCTION & PREPARED                              SPEC MIATA                                                   FORMULA E
EP, FP & BP & DP                                   Contingency also available for SCCA Runoffs                  No contingency payout is available per event;
1st Place                              $500        and June Sprints. No tow fund is available for               payout is available for SCCA Runoffs and
2nd Place                              $300        Runoffs.                                                     June Sprints. No tow fund is available for
3rd Place                              $150        1st Place                                $250                Runoffs.
Divisional                                         2nd Place                                $125                Divisional
Championship                         $1,000        Divisional                                                   Championship                             $500
                                                   Championship                            $500


SHOWROOM STOCK & TOURING                           FORMULA ATLANTIC                                             JUNE SPRINTS                              Road America
                                                                                                                Mazda offers the following contingency payout for all
SSB, SSC & T2, T3                                  1st Place                                          $500
                                                                                                                classes including Spec Miata, Formula Mazda and
1st Place                              $500        2nd Place                                          $300      Formula E at Road America's June Sprints event:
2nd Place                              $300        3rd Place                                          $150
3rd Place                              $150        Divisional                                                   1st Place                                       $1,000
Divisional                                         Championship                                    $1,000       2nd Place                                        $700
Championship                         $1,000                                                                     3rd Place                                        $400

SCCA NATIONAL RUNOFFS                              SCCA RUNOFFS TOW FUND                                        Runoffs Tow Fund Payout:
                                                                                                                1-200 miles - $0              201-400 miles - $50
All Classes                                        All Classes, except SM, FE AND FM
1st Place                            $5,000        A Runoffs Tow Fund is available to competitors that finish   401-600 miles - $100          601-800 miles - $200
                                                   in the top 3 positions in their division's final points
2nd Place                            $2,500                                                                     801-1000 miles - $300        1001-1200 miles - $400
                                                   standings. Payout is based solely on data from SCCA
3rd Place                            $1,250        showing mileage from residence (on record with SCCA)         1201-1400 miles - $500       1401 + miles - $600
                                                   zip code to Heartland Park Topeka.


Requesting Runoffs Tow Fund or Divisional Championship Contingency Awards
Complete a contingency request form with "Runoffs Tow Fund" or "Divisional Championship" entered as the event description.
A copy of the final championship points standings for your division must accompany your request.
NASA (National Auto Sport Association)

Regional Championship (Year-end Points)
All Classes (except TT)
1st Place                              $1,000          +$200 (*NASA Championship bonus)
2nd Place                               $750           + $200 (*NASA Championship bonus)
3rd Place                               $500           + $200 (*NASA Championship bonus)
4th Place                               $250
5th Place                               $150

* Mazda drivers who finish 1st, 2nd or 3rd in Regional Championship points are eligible to earn an additional $200 if they participate in the NASA
  Championship event at Mid-Ohio. To be eligible, driver must have earned all season points in a Mazda and they must be compete in the same
  class they earned their points.




NASA Championships (Mid-Ohio)
All Classes except TT)
1st Place                              $4,500
2nd Place                              $2,000
3rd Place                              $1,000
4th Place                               $750
5th Place                               $500

All TT Classes
1st Place                                $500




ARRC (American Road Race of Champions)                                                                                               Road Atlanta
All Classes / All Events
1st Place                                $500
2nd Place                                $300
3rd Place                                $150
SOLO
SCCA PRO SOLO / SOLO NATIONAL TOUR
PRO SOLO                                                 PRO SOLO Class Championship                              SOLO NATIONAL TOUR
1st Place                                        $200    1st Place                                      $1,000    1st Place                                   $200
2nd Place                                        $100    2nd Place                                       $500     2nd Place                                   $100
3rd Place                                         $50    3rd Place                                       $250     3rd Place                                    $50

PRO SOLO CHALLENGE (Open & Ladies)                       PRO SOLO Championship/Challenge                          SOLO National Championship
1st Place                                        $500    1st Place                                      $1,500    1st Place                                   $800
2nd Place                                        $250    2nd Place                                       $750     2nd Place                                   $400
3rd Place                                        $125    3rd Place                                       $325     3rd Place                                   $200




Pro Racing
American Le Mans Series
P2 CLASS                                                 P2 CLASS (Sebring & Petit Le Mans)                       P2 - Manufacturer's Championship
1st Place                                       $8,000   1st Place                                      $10,000                     $25,000
2nd Place                                       $5,000   2nd Place                                       $6,000   Payout to be determined based on
3rd Place                                       $3,000   3rd Place                                       $4,000   number of Mazda drivers finishing in top 5
4th - 6th (if no Mazda finishers 1st - 3rd)   $1,500     4th - 6th (if no Mazda finishers 1st - 3rd)   $2,000     positions within Driver's Points Championship
Grand-Am Road Racing Series
Rolex Sports Car Series
GT Class                                                GT - 24 Hours of Daytona                                GT - Manufacturer’s Championship
1st Place                                      $8,000   1st Place                                     $10,000                     $25,000
2nd Place                                      $5,000   2nd Place                                      $5,000   Payout to be determined based on
3rd Place                                      $3,000   3rd Place                                      $2,500   number of Mazda drivers finishing in top 5
4th - 6th (if no Mazda finishers 1thru 3)   $1,500      4th - 6th (if no Mazda finishers 1 thru 3)   $2,000     positions within Driver's Points Championship


Koni Challenge Series
ST                                                      ST - Manufacturer’s Championship
1st Place                                     $4,000                      $14,000
2nd Place                                     $2,000    Payout to be determined based on
3rd Place                                     $1,000    number of Mazda drivers finishing in top 5
4th - 6th (if no Mazda finishers 1thru 3)    $750       positions within Driver's Points Championship




IMSA Lites
     L3 Class Year-End Points Champion
1st Place                                      $5,000




All contingency award payments processed by IMSA
Mazda MX-5 Cup
                                   Event Payout                                                Year-End Points Championship
1st Place                       $4,500      11th Place               $           450    1st Place                                 $7,500
2nd Place                       $3,000      12th Place               $           425    2nd Place                                 $6,000
3rd Place                       $2,000      13th Place               $           400    3rd Place                                 $5,000
4th Place                       $1,000      14th Place               $           375    4th Place                                 $4,500
5th Place                        $900       15th Place               $           350    5th Place                                 $4,000
6th Place                        $800       16th Place               $           325    6th Place                                 $3,500
7th Place                        $700       17th Place               $           300    7th Place                                 $3,000
8th Place                        $600       18th Place               $           275    8th Place                                 $2,500
9th Place                        $500       19th Place               $           250    9th Place                                 $2,000
10th Place                       $475       20th Place               $           225    10th Place                                $1,500

All contingency award payments processed by SCCA Pro Racing



NASA Pro Racing
U.S. Touring Car
1st Place                       $2,000
2nd Place                       $1,000
3rd Place                        $500



SCCA SPEED World Challenge
Touring Car                                                                             Manufacturer’s Championship
1st Place                      $10,000      9th Place                          $1,750                     $25,000
2nd Place                       $6,000      10th Place                         $1,500   Payout to be determined based on
3rd Place                       $4,000      11th Place                         $1,000   number of Mazda drivers finishing in top 5
4th Place                       $3,500      12th Place                         $1,000   positions within Driver's Points Championship
5th Place                       $3,000      13th Place                         $1,000
6th Place                       $2,500      14th Place                         $1,000
7th Place                       $2,250      15th Place                         $1,000
8th Place                       $2,000      Eligible Model: Mazda6 (Touring)
Import Drag Racing
NOPI                                        BOTI (Battle of the Imports)

All Pro Classes                             All Pro Classes
1st Place                           $500    1st Place                            $500
2nd Place                           $300    2nd Place                           $300
Class Championship                 $2,000   Class Championship                 $2,000


Drifting
Formula Drift
1st Place                           $400
2nd Place                           $200



Rally
MAX Attack, NASA US Rally Championships and Rally America Events
2WD - Overall*                              2WD - Overall (Year-end points)*
1st Place                          $1,500   1st Place                          $3,000
2nd Place                           $750    2nd Place                          $1,500
3rd Place                           $500    3rd Place                          $1,000

* CURRENT MODELS ONLY (MAZDA3, MAZDA6, RX-8) - AWARD FOR OTHER MAZDA MODELS IS 25% OF AMOUNTS NOTED ABOVE



Track Events
Redline Time Attack
Team Championship (Per Division)
1st Mazda Finisher                  $500
2nd Mazda Finisher                  $300
3rd Mazda Finisher                  $150




         Mazda reserves the right to change, modify or cancel any contingency award payouts listed.
Form
(Rev. October 2007)
                                       W-9                                          Request for Taxpayer                                                                 Give form to the
                                                                                                                                                                         requester. Do not
Department of the Treasury
                                                                          Identification Number and Certification                                                        send to the IRS.
Internal Revenue Service
                                       Name (as shown on your income tax return)
See Specific Instructions on page 2.




                                       Business name, if different from above
           Print or type




                                       Check appropriate box:       Individual/Sole proprietor          Corporation         Partnership
                                                                                                                                                                           Exempt
                                          Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership)                     payee
                                           Other (see instructions)
                                       Address (number, street, and apt. or suite no.)                                                        Requester’s name and address (optional)

                                                                                                                                            MAZDASPEED MOTORSPORTS
                                       City, state, and ZIP code                                                                            CONTINGENCY REQUESTS
                                                                                                                                            1421 REYNOLDS AVE, IRVINE CA 92614
                                       List account number(s) here (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                                                     Social security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. 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 3.                                                                   or
 Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose                                                          Employer identification number
 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. citizen or other U.S. person (defined below).
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 4.

Sign                                       Signature of
Here                                       U.S. person                                                                                     Date

General Instructions                                                                                                 Definition of a U.S. person. For federal tax purposes, you are
                                                                                                                     considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted.                                                                                                     ● An individual who is a U.S. citizen or U.S. resident alien,
                                                                                                                     ● A partnership, corporation, company, or association created or
Purpose of Form                                                                                                      organized in the United States or under the laws of the United
A person who is required to file an information return with the                                                      States,
IRS must obtain your correct taxpayer identification number (TIN)                                                    ● An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate                                                              ● A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or                                                             301.7701-7).
abandonment of secured property, cancellation of debt, or
                                                                                                                     Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA.
                                                                                                                     trade or business in the United States are generally required to
   Use Form W-9 only if you are a U.S. person (including a                                                           pay a withholding tax on any foreign partners’ share of income
resident alien), to provide your correct TIN to the person                                                           from such business. Further, in certain cases where a Form W-9
requesting it (the requester) and, when applicable, to:                                                              has not been received, a partnership is required to presume that
  1. Certify that the TIN you are giving is correct (or you are                                                      a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued),                                                                                  Therefore, if you are a U.S. person that is a partner in a
                                                                                                                     partnership conducting a trade or business in the United States,
   2. Certify that you are not subject to backup withholding, or                                                     provide Form W-9 to the partnership to establish your U.S.
   3. Claim exemption from backup withholding if you are a U.S.                                                      status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a                                                       income.
U.S. person, your allocable share of any partnership income from                                                        The person who gives Form W-9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on                                                    purposes of establishing its U.S. status and avoiding withholding
foreign partners’ share of effectively connected income.                                                             on its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W-9 to                                                         conducting a trade or business in the United States is in the
request your TIN, you must use the requester’s form if it is                                                         following cases:
substantially similar to this Form W-9.
                                                                                                                     ● The U.S. owner of a disregarded entity and not the entity,
                                                                                                         Cat. No. 10231X                                               Form   W-9   (Rev. 10-2007)
Form W-9 (Rev. 10-2007)                                                                                                             Page   2
● The U.S. grantor or other owner of a grantor trust and not the         4. The IRS tells you that you are subject to backup
trust, and                                                             withholding because you did not report all your interest and
● The U.S. trust (other than a grantor trust) and not the              dividends on your tax return (for reportable interest and
beneficiaries of the trust.                                            dividends only), or
Foreign person. If you are a foreign person, do not use Form             5. You do not certify to the requester that you are not subject
W-9. Instead, use the appropriate Form W-8 (see Publication            to backup withholding under 4 above (for reportable interest and
515, Withholding of Tax on Nonresident Aliens and Foreign              dividend accounts opened after 1983 only).
Entities).                                                               Certain payees and payments are exempt from backup
                                                                       withholding. See the instructions below and the separate
Nonresident alien who becomes a resident alien. Generally,             Instructions for the Requester of Form W-9.
only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on certain types of income.       Also see Special rules for partnerships on page 1.
However, most tax treaties contain a provision known as a
“saving clause.” Exceptions specified in the saving clause may
                                                                       Penalties
permit an exemption from tax to continue for certain types of          Failure to furnish TIN. If you fail to furnish your correct TIN to a
income even after the payee has otherwise become a U.S.                requester, you are subject to a penalty of $50 for each such
resident alien for tax purposes.                                       failure unless your failure is due to reasonable cause and not to
   If you are a U.S. resident alien who is relying on an exception     willful neglect.
contained in the saving clause of a tax treaty to claim an             Civil penalty for false information with respect to
exemption from U.S. tax on certain types of income, you must           withholding. If you make a false statement with no reasonable
attach a statement to Form W-9 that specifies the following five       basis that results in no backup withholding, you are subject to a
items:                                                                 $500 penalty.
   1. The treaty country. Generally, this must be the same treaty      Criminal penalty for falsifying information. Willfully falsifying
under which you claimed exemption from tax as a nonresident            certifications or affirmations may subject you to criminal
alien.                                                                 penalties including fines and/or imprisonment.
   2. The treaty article addressing the income.                        Misuse of TINs. If the requester discloses or uses TINs in
   3. The article number (or location) in the tax treaty that          violation of federal law, the requester may be subject to civil and
contains the saving clause and its exceptions.                         criminal penalties.
  4. The type and amount of income that qualifies for the
exemption from tax.                                                    Specific Instructions
   5. Sufficient facts to justify the exemption from tax under the     Name
terms of the treaty article.
                                                                       If you are an individual, you must generally enter the name
   Example. Article 20 of the U.S.-China income tax treaty allows
                                                                       shown on your income tax return. However, if you have changed
an exemption from tax for scholarship income received by a
                                                                       your last name, for instance, due to marriage without informing
Chinese student temporarily present in the United States. Under
                                                                       the Social Security Administration of the name change, enter
U.S. law, this student will become a resident alien for tax
                                                                       your first name, the last name shown on your social security
purposes if his or her stay in the United States exceeds 5
                                                                       card, and your new last name.
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-China treaty (dated April 30, 1984) allows the provisions of         If the account is in joint names, list first, and then circle, the
Article 20 to continue to apply even after the Chinese student         name of the person or entity whose number you entered in Part I
becomes a resident alien of the United States. A Chinese               of the form.
student who qualifies for this exception (under paragraph 2 of         Sole proprietor. Enter your individual name as shown on your
the first protocol) and is relying on this exception to claim an       income tax return on the “Name” line. You may enter your
exemption from tax on his or her scholarship or fellowship             business, trade, or “doing business as (DBA)” name on the
income would attach to Form W-9 a statement that includes the          “Business name” line.
information described above to support that exemption.
                                                                       Limited liability company (LLC). Check the “Limited liability
   If you are a nonresident alien or a foreign entity not subject to   company” box only and enter the appropriate code for the tax
backup withholding, give the requester the appropriate                 classification (“D” for disregarded entity, “C” for corporation, “P”
completed Form W-8.                                                    for partnership) in the space provided.
What is backup withholding? Persons making certain payments               For a single-member LLC (including a foreign LLC with a
to you must under certain conditions withhold and pay to the           domestic owner) that is disregarded as an entity separate from
IRS 28% of such payments. This is called “backup withholding.”         its owner under Regulations section 301.7701-3, enter the
Payments that may be subject to backup withholding include             owner’s name on the “Name” line. Enter the LLC’s name on the
interest, tax-exempt interest, dividends, broker and barter            “Business name” line.
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate                For an LLC classified as a partnership or a corporation, enter
transactions are not subject to backup withholding.                    the LLC’s name on the “Name” line and any business, trade, or
                                                                       DBA name on the “Business name” line.
   You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make the       Other entities. Enter your business name as shown on required
proper certifications, and report all your taxable interest and        federal tax documents on the “Name” line. This name should
dividends on your tax return.                                          match the name shown on the charter or other legal document
                                                                       creating the entity. You may enter any business, trade, or DBA
Payments you receive will be subject to backup                         name on the “Business name” line.
withholding if:                                                        Note. You are requested to check the appropriate box for your
   1. You do not furnish your TIN to the requester,                    status (individual/sole proprietor, corporation, etc.).
   2. You do not certify your TIN when required (see the Part II       Exempt Payee
instructions on page 3 for details),
   3. The IRS tells the requester that you furnished an incorrect      If you are exempt from backup withholding, enter your name as
TIN,                                                                   described above and check the appropriate box for your status,
                                                                       then check the “Exempt payee” box in the line following the
                                                                       business name, sign and date the form.
Form W-9 (Rev. 10-2007)                                                                                                                         Page   3
Generally, individuals (including sole proprietors) are not exempt                  Part I. Taxpayer Identification
from backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.                   Number (TIN)
Note. If you are exempt from backup withholding, you should                         Enter your TIN in the appropriate box. If you are a resident
still complete this form to avoid possible erroneous backup                         alien and you do not have and are not eligible to get an SSN,
withholding.                                                                        your TIN is your IRS individual taxpayer identification number
   The following payees are exempt from backup withholding:                         (ITIN). Enter it in the social security number box. If you do not
                                                                                    have an ITIN, see How to get a TIN below.
   1. An organization exempt from tax under section 501(a), any
IRA, or a custodial account under section 403(b)(7) if the account                     If you are a sole proprietor and you have an EIN, you may
satisfies the requirements of section 401(f)(2),                                    enter either your SSN or EIN. However, the IRS prefers that you
                                                                                    use your SSN.
   2. The United States or any of its agencies or                                      If you are a single-member LLC that is disregarded as an
instrumentalities,                                                                  entity separate from its owner (see Limited liability company
  3. A state, the District of Columbia, a possession of the United                  (LLC) on page 2), enter the owner’s SSN (or EIN, if the owner
States, or any of their political subdivisions or instrumentalities,                has one). Do not enter the disregarded entity’s EIN. If the LLC is
  4. A foreign government or any of its political subdivisions,                     classified as a corporation or partnership, enter the entity’s EIN.
agencies, or instrumentalities, or                                                  Note. See the chart on page 4 for further clarification of name
   5. An international organization or any of its agencies or                       and TIN combinations.
instrumentalities.                                                                  How to get a TIN. If you do not have a TIN, apply for one
                                                                                    immediately. To apply for an SSN, get Form SS-5, Application
   Other payees that may be exempt from backup withholding                          for a Social Security Card, from your local Social Security
include:                                                                            Administration office or get this form online at www.ssa.gov. You
   6. A corporation,                                                                may also get this form by calling 1-800-772-1213. Use Form
  7. A foreign central bank of issue,                                               W-7, Application for IRS Individual Taxpayer Identification
  8. A dealer in securities or commodities required to register in                  Number, to apply for an ITIN, or Form SS-4, Application for
the United States, the District of Columbia, or a possession of                     Employer Identification Number, to apply for an EIN. You can
the United States,                                                                  apply for an EIN online by accessing the IRS website at
                                                                                    www.irs.gov/businesses and clicking on Employer Identification
   9. A futures commission merchant registered with the                             Number (EIN) under Starting a Business. You can get Forms W-7
Commodity Futures Trading Commission,                                               and SS-4 from the IRS by visiting www.irs.gov or by calling
  10. A real estate investment trust,                                               1-800-TAX-FORM (1-800-829-3676).
  11. An entity registered at all times during the tax year under                      If you are asked to complete Form W-9 but do not have a TIN,
the Investment Company Act of 1940,                                                 write “Applied For” in the space for the TIN, sign and date the
                                                                                    form, and give it to the requester. For interest and dividend
  12. A common trust fund operated by a bank under section                          payments, and certain payments made with respect to readily
584(a),                                                                             tradable instruments, generally you will have 60 days to get a
  13. A financial institution,                                                      TIN and give it to the requester before you are subject to backup
  14. A middleman known in the investment community as a                            withholding on payments. The 60-day rule does not apply to
nominee or custodian, or                                                            other types of payments. You will be subject to backup
                                                                                    withholding on all such payments until you provide your TIN to
  15. A trust exempt from tax under section 664 or described in                     the requester.
section 4947.
                                                                                    Note. Entering “Applied For” means that you have already
  The chart below shows types of payments that may be                               applied for a TIN or that you intend to apply for one soon.
exempt from backup withholding. The chart applies to the                            Caution: A disregarded domestic entity that has a foreign owner
exempt payees listed above, 1 through 15.                                           must use the appropriate Form W-8.
IF the payment is for . . .                 THEN the payment is exempt              Part II. Certification
                                            for . . .
                                                                                    To establish to the withholding agent that you are a U.S. person,
Interest and dividend payments              All exempt payees except                or resident alien, sign Form W-9. You may be requested to sign
                                            for 9                                   by the withholding agent even if items 1, 4, and 5 below indicate
Broker transactions                         Exempt payees 1 through 13.             otherwise.
                                            Also, a person registered under            For a joint account, only the person whose TIN is shown in
                                            the Investment Advisers Act of          Part I should sign (when required). Exempt payees, see Exempt
                                            1940 who regularly acts as a            Payee on page 2.
                                            broker                                  Signature requirements. Complete the certification as indicated
Barter exchange transactions                Exempt payees 1 through 5               in 1 through 5 below.
and patronage dividends                                                                1. Interest, dividend, and barter exchange accounts
                                                                                    opened before 1984 and broker accounts considered active
Payments over $600 required                 Generally, exempt payees
                                                        2                           during 1983. You must give your correct TIN, but you do not
to be reported and direct                   1 through 7                             have to sign the certification.
                  1
sales over $5,000
                                                                                       2. Interest, dividend, broker, and barter exchange
1                                                                                   accounts opened after 1983 and broker accounts considered
    See Form 1099-MISC, Miscellaneous Income, and its instructions.
2                                                                                   inactive during 1983. You must sign the certification or backup
    However, the following payments made to a corporation (including gross
    proceeds paid to an attorney under section 6045(f), even if the attorney is a
                                                                                    withholding will apply. If you are subject to backup withholding
    corporation) and reportable on Form 1099-MISC are not exempt from               and you are merely providing your correct TIN to the requester,
    backup withholding: medical and health care payments, attorneys’ fees, and      you must cross out item 2 in the certification before signing the
    payments for services paid by a federal executive agency.                       form.
Form W-9 (Rev. 10-2007)                                                                                                                                           Page   4
   3. Real estate transactions. You must sign the certification.                                     Secure Your Tax Records from Identity Theft
You may cross out item 2 of the certification.
                                                                                                     Identity theft occurs when someone uses your personal
   4. Other payments. You must give your correct TIN, but you                                        information such as your name, social security number (SSN), or
do not have to sign the certification unless you have been                                           other identifying information, without your permission, to commit
notified that you have previously given an incorrect TIN. “Other                                     fraud or other crimes. An identity thief may use your SSN to get
payments” include payments made in the course of the                                                 a job or may file a tax return using your SSN to receive a refund.
requester’s trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services                                           To reduce your risk:
(including payments to corporations), payments to a                                                  ● Protect your SSN,
nonemployee for services, payments to certain fishing boat crew                                      ● Ensure your employer is protecting your SSN, and
members and fishermen, and gross proceeds paid to attorneys                                          ● Be careful when choosing a tax preparer.
(including payments to corporations).
                                                                                                        Call the IRS at 1-800-829-1040 if you think your identity has
  5. Mortgage interest paid by you, acquisition or                                                   been used inappropriately for tax purposes.
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,                                            Victims of identity theft who are experiencing economic harm
Coverdell ESA, Archer MSA or HSA contributions or                                                    or a system problem, or are seeking help in resolving tax
distributions, and pension distributions. You must give your                                         problems that have not been resolved through normal channels,
correct TIN, but you do not have to sign the certification.                                          may be eligible for Taxpayer Advocate Service (TAS) assistance.
                                                                                                     You can reach TAS by calling the TAS toll-free case intake line
                                                                                                     at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
What Name and Number To Give the Requester
                                                                                                     Protect yourself from suspicious emails or phishing
          For this type of account:                         Give name and SSN of:                    schemes. Phishing is the creation and use of email and
                                                                                                     websites designed to mimic legitimate business emails and
    1. Individual                                    The individual
                                                                                                     websites. The most common act is sending an email to a user
    2. Two or more individuals (joint                The actual owner of the account or,
       account)                                      if combined funds, the first
                                                                                                     falsely claiming to be an established legitimate enterprise in an
                                                     individual on the account
                                                                               1
                                                                                                     attempt to scam the user into surrendering private information
    3. Custodian account of a minor                  The minor
                                                                 2                                   that will be used for identity theft.
       (Uniform Gift to Minors Act)
                                                                               1
                                                                                                        The IRS does not initiate contacts with taxpayers via emails.
    4. a. The usual revocable savings                The grantor-trustee                             Also, the IRS does not request personal detailed information
       trust (grantor is also trustee)                                                               through email or ask taxpayers for the PIN numbers, passwords,
                                                                           1
       b. So-called trust account that is            The actual owner                                or similar secret access information for their credit card, bank, or
       not a legal or valid trust under                                                              other financial accounts.
       state law
    5. Sole proprietorship or disregarded            The owner
                                                                   3
                                                                                                        If you receive an unsolicited email claiming to be from the IRS,
       entity owned by an individual                                                                 forward this message to phishing@irs.gov. You may also report
                                                            Give name and EIN of:
                                                                                                     misuse of the IRS name, logo, or other IRS personal property to
          For this type of account:
                                                                                                     the Treasury Inspector General for Tax Administration at
 6. Disregarded entity not owned by an               The owner                                       1-800-366-4484. You can forward suspicious emails to the
    individual                                                                                       Federal Trade Commission at: spam@uce.gov or contact them at
                                                                       4
 7. A valid trust, estate, or pension trust          Legal entity                                    www.consumer.gov/idtheft or 1-877-IDTHEFT(438-4338).
 8. Corporate or LLC electing                        The corporation
    corporate status on Form 8832                                                                      Visit the IRS website at www.irs.gov to learn more about
 9. Association, club, religious,                    The organization                                identity theft and how to reduce your risk.
    charitable, educational, or other
    tax-exempt organization
10. Partnership or multi-member LLC                  The partnership
11. A broker or registered nominee                   The broker or nominee
12. Account with the Department of                   The public entity
    Agriculture in the name of a public
    entity (such as a state or local
    government, school district, or
    prison) that receives agricultural
    program payments
1
    List first and circle the name of the person whose number you furnish. If only one person
    on a joint account has an SSN, that person’s number must be furnished.
2
    Circle the minor’s name and furnish the minor’s SSN.
3
    You must show your individual name and you may also enter your business or “DBA”
    name on the second name line. You may use either your SSN or EIN (if you have one),
    but the IRS encourages you to use your SSN.
4
    List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
    of the personal representative or trustee unless the legal entity itself is not designated in
    the account title.) Also see Special rules for partnerships on page 1.

Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.

Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
  You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.

								
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