TAX ID Verification Name(Required) as shown on your income tax return Is business name different from name in your income tax return? Business name Check appropriate box(Required) Individual/Sole proprietor Corporation Partnership Limited liability company Other Enter the tax classification D=disregarded entity, C=corporation, P=partnershipExempt payee?(Required) Yes No Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Social security number orEmployer identification number Signature of U.S. person(Required)Date(Required) Month Day Year Δ
