W-9 Form - Request for Taxpayer Identification Number and Certification
| 1. Name (as shown on your income tax return) | John Doe |
|---|---|
| 2. Business name, if different from above | Doe Enterprises |
| 3. Federal tax classification | Individual |
| 4. Exemptions | No exemptions |
| 5. Address (home or business) | 123 Main St, Anytown, USA |
| 6. City, state, and ZIP code | Anytown, CA 12345 |
| 7. List account number(s) here (optional) | 987654321 |
| 8. Social Security number | 123-45-6789 |
| 9. Employer identification number (EIN) | 98-7654321 |
| 10. Certification |
I certify that the information provided is true and correct. I am subject to backup withholding unless I am exempt. Signature: ____________________________ Date: ________________ |
